Society of Critical Care Medicine Clinical Practice Guidelines on Adult End-of-Life Care in the ICU

RATIONALE: Evidence-based practice has evolved significantly since the release of the 2008 American College of Critical Care Medicine (ACCM) Consensus Statement of recommendations for end-of-life (EOL) care in the ICU. These guidelines represent new knowledge and address previously unconsidered issues.

OBJECTIVE: To identify and disseminate evidence-based recommendations based on current research to better understand how to deliver appropriate and effective adult EOL care in the ICU.

INTRODUCTION: A multidisciplinary team approach to EOL care in the ICU is crucial regardless of age. Up to 20% of ICU patients have goals that are not medically attainable or their treatment plan does not align with their achievable goals. Thus, it is paramount that we better understand how to assist with decision-making, mitigate conflict about treatment goals, address suffering, and enhance capacity for adult EOL care in the ICU. This includes detailed knowledge of how EOL care fits into the delivery of high-quality ICU care as well as into such processes as organ donation. Further discussion of organ donation is beyond the scope of this guideline. We refer you to your health system policies and local state laws for further information regarding discussion of organ donation. Recognizing that terminology may vary between regions, we provide a supplementary glossary of terms commonly used in EOL care.

The Society of Critical Care Medicine

Mary Faith Marshall, F Daniel Davis, Patricia A Fogelman, Simon Oczkowski, Julie C Reid, Daniel Arellano, Rebecca A Aslakson, Joshua Campbell, Katherine Courtright, Katarine Egressy, Elizabeth Epstein, Ebonye Green, May Hua, Preeti R John, Erin K Kross, Niels D Martin, Bethany A Melo, Susanne Muehlschlegel, Silvia Perez-Protto, Ben Roberts, Daniel Shalev, Jennifer Wescoe Singley, Shawna L Strickland, Karen A Korzick