BookMassimo Romanò, editor.
Summary: This book analyzes the main topics of Palliative Care in Cardiac Intensive Care Units (CICU), from the changing epidemiology of patients admitted to the ICU, to the main clinical and ethical issues. The changing epidemiology of patients has led to new and emerging patient needs at the end of life. Care has shifted from acute coronary syndrome patients towards elderly patients, with a high prevalence of non-ischemic cardiovascular diseases and a high burden of non-cardiovascular comorbid conditions: both increase the susceptibility of patients to developing life-threatening critical conditions. These conditions are associated with a significant symptom burden, high mortality rate, and increased length of stay. The main new challenges involve shared decision-making, symptom control (pain, dyspnea, etc.), and ethical issues (withholding/withdrawing life sustaining treatments, deactivation of implanted cardiac devices, palliative sedation), all of which necessitate formal education on end-of-life care. Written by opinion leaders in their respective fields, who share their experience with improving the cultural and clinical competence of medical/nursing teams, this volume is chiefly intended for cardiologists, anesthesiologists, palliative care doctors and nursing staff.
Contents:
Intro
Foreword
Preface
Acknowledgements
Contents
About the Author
1: Epidemiology and Patterns of Care in Modern Cardiac Intensive Care Units
1.1 Introduction
1.2 Is There a Background for the Evolution of CICU? From the Blitz-3 to Modern International CICU Registries
1.3 Aging, Comorbidity, and the Risk of Futility in CICU
1.4 The COVID-19 Tsunami and Its Effect on CICU
1.5 Conclusions
References
2: The Intensive and Advanced Treatments in the Cardiac Intensive Care Units
2.1 Introduction
2.2 Cardiac Arrest and Post-cardiac Arrest Syndrome 2.3 Advanced Heart Failure and End-Stage Heart Failure
2.4 Cardiogenic Shock (CS) and Low-Output Syndrome
2.5 Mechanical Circulatory Supports (MCSs)
2.6 Heart Replacement Therapies
2.7 Cardiac Implanted Electronic Devices (CIEDs)
2.8 Palliative Care in CICU
2.9 Palliative Inotrope Care
References
3: Symptom Assessment and Management
3.1 The Cardiologist's Palliative Competencies
3.2 Measuring a Symptom
3.2.1 Dyspnea
3.2.2 Pain
3.2.3 Thirst
3.3 Cognitive and Mood Disorders
3.3.1 Fatigue
3.3.2 Gastrointestinal Symptoms
References 4: The Meanings of Prognosis: When and How to Discuss It?
4.1 Introduction
4.2 Deciding Between Prognosis and Uncertainty
4.3 Criteria for Prognosis Definition
4.4 Communicating Prognosis
4.5 Barriers to Communication
4.5.1 The Disease
4.5.2 The Patient
4.5.3 Treatment Approach
4.5.4 The Doctor
4.6 Conclusions
References
5: Informed Consent, Advance Directives, and Shared Care Planning
5.1 Introduction
5.2 Legal and Ethical Aspects
5.3 Shared Care Planning and Advance Directives in Cardiology
5.4 Conclusions
References 6: Withholding or Withdrawing Life-Sustaining Treatments
6.1 Introduction
6.2 Forgoing Life-Sustaining Treatments: The Clinical Practice
6.3 Physician Preferences
6.4 Withdrawing Life-Sustaining Treatment: Arguments in Favor
6.5 Withholding Life-Sustaining Treatment: Arguments in Favor
6.6 Withdrawing or Withholding Life-Sustaining Treatments: Means or Goals?
6.7 Forgoing Life-Sustaining Treatments: How to Do
6.7.1 Ethical Principles
6.7.2 Decision to Forgo Life-Sustaining Treatments: Theoretical Approach 6.7.3 Decision to Forgo Life-Sustaining Treatments: The Goals
6.7.4 Withdrawing Life-Sustaining Treatments: Basics in Clinical Practice
6.8 Conclusions
References
7: Deactivation of Cardiac Implantable Electronic Devices (CIEDs) at the End of Life
7.1 Introduction
7.2 Implantable Cardioverter-Defibrillators (ICDs)
7.2.1 Ethical Problems
7.2.2 Information and Patient Awareness
7.2.3 The Opinion of Physicians and Nurses
7.3 Cardiac Pacemaker (PM)-Cardiac Resynchronisation Therapy-Pacemaker (CRT-P)
7.4 Conclusions
References