European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Jozef Kesecioglu¹, Katerina Rusinova², Daniela Alampi³, Yaseen M Arabi⁴, Julie Benbenishty⁵, Dominique Benoit^{6

7}, Carole Boulanger⁸, Maurizio Cecconi^{9

10}, Christopher Cox¹¹, Marjel van Dam¹², Diederik van Dijk¹², James Downar^{13

14}, Nikolas Efstathiou¹⁵, Ruth Endacott¹⁶, Alessandro Galazzi¹⁷, Fiona van Gelder¹⁸, Rik T Gerritsen¹⁹, Armand Girbes²⁰, Laura Hawyrluck²¹, Margaret Herridge^{22

23}, Jan Hudec^{24

25}, Nancy Kentish-Barnes²⁶, Monika Kerckhoffs¹², Jos M Latour^{27

28

29}, Jan Malaska^{25

30

31}, Annachiara Marra³², Stephanie Meddick-Dyson³³, Spyridon Mentzelopoulos³⁴, Mervyn Mer^{35

36}, Victoria Metaxa^{37

38}, Andrej Michalsen³⁹, Rajesh Mishra⁴⁰, Giovanni Mistraletti^{41

42}, Margo van Mol⁴³, Rui Moreno^{44

45

46}, Judith Nelson⁴⁷, Andrea Ortiz Suñer^{48

49}, Natalie Pattison^{50

51}, Tereza Prokopova^{24

25}, Kathleen Puntillo⁵², Kathryn Puxty^{53

54}, Samah Al Qahtani⁴, Lukas Radbruch⁵⁵, Emilio Rodriguez-Ruiz^{56

57

58}, Ron Sabar⁵⁹, Stefan J Schaller⁶⁰, Shahla Siddiqui⁶¹, Charles L Sprung⁶², Michele Umbrello⁴², Marco Vergano⁶³, Massimo Zambon⁶⁴, Marieke Zegers⁶⁵, Michael Darmon^{66

67}, Elie Azoulay^{66

67}

Affiliations

¹ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. j.kesecioglu@umcutrecht.nl.
² Department of Palliative Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.
³ Sapienza University of Rome, A.O.U. Sant'Andrea, Rome, Italy.
⁴ Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
⁵ Faculty of Medicine, School of Nursing, Hebrew University, Jerusalem, Israel.
⁶ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
⁷ Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
⁸ Royal Devon University NHS Foundation Trust, Exeter, UK.
⁹ Biomedical Sciences Department, Humanitas University, Milan, Italy.
¹⁰ Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
¹¹ Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC, USA.
¹² Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹³ Department of Medicine, University of Ottawa, Ottawa, Canada.
¹⁴ Bruyere Research Institute, Ottawa, Canada.
¹⁵ School of Nursing and Midwifery, University of Birmingham, Birmingham, UK.
¹⁶ National Institute for Health and Care Research, London, UK.
¹⁷ Department of Medicine, University of Udine, Udine, Italy.
¹⁸ Gelderse Vallei Hospital, Ede, The Netherlands.
¹⁹ Centrum Voor Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
²⁰ Department of Critical Care, AmsterdamUMC Location VUmc, Amsterdam, The Netherlands.
²¹ Interdepartmental Division Critical Care Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.
²² Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Toronto, Canada.
²³ Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
²⁴ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
²⁵ Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia.
²⁶ Famiréa Research Group, APHP Nord, Saint Louis Hospital, Intensive Care Unit, Paris, France.
²⁷ School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
²⁸ Curtin School of Nursing, Curtin University, Perth, Australia.
²⁹ Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
³⁰ Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
³¹ Second Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czechia.
³² Department of Neuroscience, Reproductive Science and Dentistry, University of Naples, Naples, Italy.
³³ Wolfson Palliative Care Research Centre, Hull York, Medical School, University of Hull, Hull, UK.
³⁴ First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece.
³⁵ Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa.
³⁶ Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³⁷ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
³⁸ King's College London, London, UK.
³⁹ Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Konstanz Hospital, Constance, Germany.
⁴⁰ Ahmedabad Shaibya Comprehensive Care Clinic, Ahmedabad, India.
⁴¹ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
⁴² S.C. Anesthesia and Intensive Care, Legnano Hospital, ASST Ovest Milanese, Milan, Italy.
⁴³ Department of Intensive Care Adults, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
⁴⁴ Hospital de São José, Unidade Local de Saúde São José, Lisbon, Portugal.
⁴⁵ Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Centro Clínico Académico de Lisboa, Lisbon, Portugal.
⁴⁶ Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.
⁴⁷ Memorial Hospital, Weill Cornell Medical College, New York, NY, USA.
⁴⁸ Hospital Arnau de Vilanova-Lliria, Valencia, Spain.
⁴⁹ Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
⁵⁰ University of Hertfordshire, East and North Hertfordshire NHS Trust, Hatfield, UK.
⁵¹ Imperial Healthcare NHS Trust, Imperial College, London, UK.
⁵² School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
⁵³ Intensive Care, Glasgow Royal Infirmary, Glasgow, UK.
⁵⁴ University of Glasgow, Glasgow, UK.
⁵⁵ Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
⁵⁶ Department of Intensive Care Medicine, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain.
⁵⁷ Simulation, Life Support and Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
⁵⁸ CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
⁵⁹ Sabar Health, Netanya, Israel.
⁶⁰ Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
⁶¹ Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁶² Department of Anesthesiology, Critical Care Medicine and Pain, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
⁶³ Department of Anesthesia, Intensive Care and Emergency, San Giovanni Bosco Hospital, Turin, Italy.
⁶⁴ Anesthesia and Intensive Care Ospedale "Uboldo", Cernusco sul Naviglio, Milan, Italy.
⁶⁵ Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶⁶ Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris, France.
⁶⁷ Université Paris Cité, Paris, France.

PMID: 39361081
PMCID: PMC11541285
DOI: 10.1007/s00134-024-07579-1

Practice Guideline

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Jozef Kesecioglu et al. Intensive Care Med. 2024 Nov.

. 2024 Nov;50(11):1740-1766.

doi: 10.1007/s00134-024-07579-1. Epub 2024 Oct 3.

Authors

Affiliations

¹ Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands. j.kesecioglu@umcutrecht.nl.
² Department of Palliative Medicine, 1st Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czechia.
³ Sapienza University of Rome, A.O.U. Sant'Andrea, Rome, Italy.
⁴ Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences and King Abdullah International Medical Research Center, Ministry of National Guard-Health Affairs, Riyadh, Saudi Arabia.
⁵ Faculty of Medicine, School of Nursing, Hebrew University, Jerusalem, Israel.
⁶ Department of Intensive Care Medicine, Ghent University Hospital, Ghent, Belgium.
⁷ Faculty of Medicine and Health Science, Ghent University, Ghent, Belgium.
⁸ Royal Devon University NHS Foundation Trust, Exeter, UK.
⁹ Biomedical Sciences Department, Humanitas University, Milan, Italy.
¹⁰ Department of Anaesthesia and Intensive Care, IRCCS Humanitas Research Hospital, Milan, Italy.
¹¹ Division of Pulmonary and Critical Care Medicine, Duke University, Durham, NC, USA.
¹² Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹³ Department of Medicine, University of Ottawa, Ottawa, Canada.
¹⁴ Bruyere Research Institute, Ottawa, Canada.
¹⁵ School of Nursing and Midwifery, University of Birmingham, Birmingham, UK.
¹⁶ National Institute for Health and Care Research, London, UK.
¹⁷ Department of Medicine, University of Udine, Udine, Italy.
¹⁸ Gelderse Vallei Hospital, Ede, The Netherlands.
¹⁹ Centrum Voor Intensive Care, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands.
²⁰ Department of Critical Care, AmsterdamUMC Location VUmc, Amsterdam, The Netherlands.
²¹ Interdepartmental Division Critical Care Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Canada.
²² Critical Care and Respiratory Medicine, University Health Network, Toronto General Research Institute, Toronto, Canada.
²³ Institute of Medical Sciences, Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada.
²⁴ Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
²⁵ Department of Simulation Medicine, Faculty of Medicine, Masaryk University, Brno, Czechia.
²⁶ Famiréa Research Group, APHP Nord, Saint Louis Hospital, Intensive Care Unit, Paris, France.
²⁷ School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK.
²⁸ Curtin School of Nursing, Curtin University, Perth, Australia.
²⁹ Department of Nursing, Zhongshan Hospital, Fudan University, Shanghai, China.
³⁰ Department of Paediatric Anaesthesiology and Intensive Care Medicine, University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czechia.
³¹ Second Department of Anaesthesiology and Intensive Care Medicine, University Hospital Brno, Brno, Czechia.
³² Department of Neuroscience, Reproductive Science and Dentistry, University of Naples, Naples, Italy.
³³ Wolfson Palliative Care Research Centre, Hull York, Medical School, University of Hull, Hull, UK.
³⁴ First Department of Intensive Care Medicine, National and Kapodistrian University of Athens Medical School, Evaggelismos General Hospital, Athens, Greece.
³⁵ Department of Medicine, Divisions of Critical Care and Pulmonology, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), Johannesburg, South Africa.
³⁶ Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
³⁷ Department of Critical Care, King's College Hospital NHS Foundation Trust, London, UK.
³⁸ King's College London, London, UK.
³⁹ Department of Anesthesiology, Critical Care, Emergency Medicine and Pain Therapy, Konstanz Hospital, Constance, Germany.
⁴⁰ Ahmedabad Shaibya Comprehensive Care Clinic, Ahmedabad, India.
⁴¹ Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy.
⁴² S.C. Anesthesia and Intensive Care, Legnano Hospital, ASST Ovest Milanese, Milan, Italy.
⁴³ Department of Intensive Care Adults, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, The Netherlands.
⁴⁴ Hospital de São José, Unidade Local de Saúde São José, Lisbon, Portugal.
⁴⁵ Faculdade de Ciências Médicas de Lisboa, Nova Medical School, Centro Clínico Académico de Lisboa, Lisbon, Portugal.
⁴⁶ Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.
⁴⁷ Memorial Hospital, Weill Cornell Medical College, New York, NY, USA.
⁴⁸ Hospital Arnau de Vilanova-Lliria, Valencia, Spain.
⁴⁹ Universidad Católica de Valencia San Vicente Mártir, Valencia, Spain.
⁵⁰ University of Hertfordshire, East and North Hertfordshire NHS Trust, Hatfield, UK.
⁵¹ Imperial Healthcare NHS Trust, Imperial College, London, UK.
⁵² School of Nursing, University of California, San Francisco, San Francisco, CA, USA.
⁵³ Intensive Care, Glasgow Royal Infirmary, Glasgow, UK.
⁵⁴ University of Glasgow, Glasgow, UK.
⁵⁵ Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany.
⁵⁶ Department of Intensive Care Medicine, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain.
⁵⁷ Simulation, Life Support and Intensive Care Research Unit of Santiago de Compostela (SICRUS), Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain.
⁵⁸ CLINURSID Research Group, University of Santiago de Compostela, Santiago de Compostela, Spain.
⁵⁹ Sabar Health, Netanya, Israel.
⁶⁰ Department of Anaesthesiology and Intensive Care Medicine (CCM/CVK), Charité-Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany.
⁶¹ Department of Anesthesia Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
⁶² Department of Anesthesiology, Critical Care Medicine and Pain, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
⁶³ Department of Anesthesia, Intensive Care and Emergency, San Giovanni Bosco Hospital, Turin, Italy.
⁶⁴ Anesthesia and Intensive Care Ospedale "Uboldo", Cernusco sul Naviglio, Milan, Italy.
⁶⁵ Department of Intensive Care, Radboud University Medical Center, Nijmegen, The Netherlands.
⁶⁶ Médecine Intensive et Réanimation, APHP, Saint-Louis Hospital, Paris, France.
⁶⁷ Université Paris Cité, Paris, France.

PMID: 39361081
PMCID: PMC11541285
DOI: 10.1007/s00134-024-07579-1

Abstract

The European Society of Intensive Care Medicine (ESICM) has developed evidence-based recommendations and expert opinions about end-of-life (EoL) and palliative care for critically ill adults to optimize patient-centered care, improving outcomes of relatives, and supporting intensive care unit (ICU) staff in delivering compassionate and effective EoL and palliative care. An international multi-disciplinary panel of clinical experts, a methodologist, and representatives of patients and families examined key domains, including variability across countries, decision-making, palliative-care integration, communication, family-centered care, and conflict management. Eight evidence-based recommendations (6 of low level of evidence and 2 of high level of evidence) and 19 expert opinions were presented. EoL legislation and the importance of respecting the autonomy and preferences of patients were given close attention. Differences in EoL care depending on country income and healthcare provision were considered. Structured EoL decision-making strategies are recommended to improve outcomes of patients and relatives, as well as staff satisfaction and mental health. Early integration of palliative care and the use of standardized tools for symptom assessment are suggested for patients at high risk of dying. Communication training for ICU staff and printed communication aids for families are advocated to improve outcomes and satisfaction. Methods for enhancing family-centeredness of care include structured family conferences and culturally sensitive interventions. Conflict-management protocols and strategies to prevent burnout among healthcare professionals are also considered. The work done to develop these guidelines highlights many areas requiring further research.

Keywords: Communication; Conflict management; Cultural variations; Decision-making; End of life; Family-centered care; GRADE; Intensive care unit; Palliative care.

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Conflict of interest statement

AMi reports travel cost reimbursement for the ESICM 2022 and 2023 annual congresses. CC received honoraria for lectures, and support for attending meetings (NIH grants). He is also member of two DSMBs in the field of pall care and mindfulness. EA declares honoraria for Lectures from GILEAD, PFIZER, SANOFI, ALEXION and receipt of drugs for running a clinical trial (PFIZER). LH is President and CEO of Medical Corporation she has appeared, and her corporation has been paid for expert testimony in legal matters in Canada that pertain to allegations of negligence in critical care medicine in which patients have died. I have also been paid for expert testimony in a criminal case in EOL care in Canada. She received free admission to the ESICM 2023 meeting for all her work for ESICM not solely for this project. JD received payment for expert testimony in a criminal trial in Canada. JM received grants supporting the implementation of palliative care in undergraduate teaching at the Faculty of Medicine in the Czech Republic (Czech Society of Palliative Medicine, Faculty of Medicine, Masaryk University Brno, 1661/2023), for the diagnosis of superinfections in patients with COVID-19 pneumonia on mechanical ventilation (Ministry of Health, Prague[CZ], Grant number: NU22-B-122) and supporting further development of excellence in SP General Medicine Introduction of Objective Structured Clinical Examination (OSCE) and related modifications to the teaching of Intensive Care Medicine (MUNI/ESPRO/0850/2023 and MUNI/IVV/0770/2023). He is member of the Scientific Board BAZE-X1, OxygenBiotech. JK received support for travel and honorarium from Draeger Medical Equipment (Shanghai) Co., Ltd for approximately 2.5 days of academic lectures given in Tianjin during the CSCCM meeting 25-27 May 2023. KP declares a research grant FAME: as a member of the grant’s Scientific Review Committee, she was provided financial support (i.e., travel and accommodations), to attend a meeting in Paris, France in October 2023. She is Chair of the Data Safety Monitoring Committee for the University of Washington “Facilitating Communication Study”, and NIH-sponsored grant (no financial compensation for this work). MSH received honorarium for Grenvik lecture University of Pittsburgh Sept 2023. She received support for travel (ESICM 2023 annual meeting). MV received honoraria for lessons and lectures from CNT (Italian National Transplant Authority), Getinge/Maquet, University of Torino, University of Milano-Bicocca, BSC (Belgian Society of Cardiology). He received travel and accommodation support for lectures and lessons (without honoraria) from SIAARTI (Italian College of Anesthesia and Intensive Care), GiViTI (Gruppo Italiano Valutazione Interventi in Terapia Intensiva), different Universities and healthcare institutions in Italy. He is member of the DSMB for the ENFORCER Study, past Chair and current board member of the Ethics Section of SIAARTI, and member of the Institutional Review Board of EMERGENCY NGO. MD is General secretary and member of the council of the French Society of intensive care medicine (2019-2024). GM is member of the DSMB of the ALBIOSS-BALANCED study and member of the Ethics Committee “Comitato Etico Territoriale n.4 della Lombardia” – IRCCS Istituto Nazionale dei Tumori, Milano, Italy. NK-B received grant from the Agence Nationale de la Recherche, France. NP received grants from the National Institute for Health Research and the RCN Foundation. She is chair of Trustees and Chair of National Outreach Forum (registered UK charity 1181360 – unpaid). JN received grant from the NIH, National Institute of Nursing Research. She received support for attending meeting (University Hospital Research in Health (RHU-5) – October 2023 meeting for “FAME” Project (Agence Nationale de la Recherche-France) Scientific Advisory Board. She is member of the Scientific Advisory Board - FAME” Project (Agence Nationale de la Recherche-France) and NHLBI project. LR is Chair of the Board of Directors of the International Association for Hospice and Palliative Care. RTG received support for travel and accommodation (ESICM LIVES 2023). He is member of the NVIC ethics committee. RE received grant from the National Institute for Health & care Research, UK. She is Director of the National Institute for health & care Research, UK and Trustee/Director, Intensive Care National Audit and Research Centre (ICNARC), UK. SJS received grants from: STIMIT AG, Switzerland; Fresenius Kabi Gmbh, Germany; ASP Gmbh, Germany; Reactive Robotics GmbH, Germany; Innovationsfond of The Federal Joint Committee (G-BA), Germany; ESICM, Switzerland. He received honoraria for lectures from Springer Verlag GmbH, Austria, Advanz Pharma GmbH, Germany and Fresenius Kabi Gmbh, Germany. He received financial support for attending meetings from National (e.g., DGAI) or international (e.g., ESICM) medical societies in the field of anesthesiology and intensive care and their congress organizers and from Charité – Universitätsmedizin Berlin. He is member of the DSMB of the MIDAS Study (PMID: 32885276). He declares fiduciary role in the TiFoNet of the DGAI, Germany. He has stock option from Alphabet Inc., Siemens AG, and Bayer AG. CLS received honoraria from hospitals for lectures on “ICU worldwide end of life practices”. SM declares grant from the EUROPEAN HEALTH AND DIGITAL EXECUTIVE AGENCY (HADEA) - Project 101137221 — EPIC (Enhancing Palliative Care in ICU]. All the other authors have no conflicts of interest to declare.

Figures

**Fig. 1**
Evidence plot reporting findings in PICOs with low- or high-level evidence recommendations

See this image and copyright information in PMC

References

1. Sprung CL, Ricou B, Hartog CS et al (2019) Changes in end-of-life practices in European intensive care units from 1999 to 2016. JAMA 322:1–12. 10.1001/jama.2019.14608 - PMC - PubMed
1. Kelley AS, Morrison RS (2015) Palliative care for the seriously ill. N Engl J Med 373:747–755. 10.1056/NEJMra1404684 - PMC - PubMed
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1. Azoulay E, Metnitz B, Sprung C et al (2009) End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med 35:623–630. 10.1007/s00134-008-1310-6 - PubMed
1. Sprung CL, Cohen SL, Sjokvist P et al (2003) End-of-life practices in European intensive care units: the Ethicus Study. JAMA 290:790–797. 10.1001/jama.290.6.790 - PubMed

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European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Affiliations

European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

LinkOut - more resources

Full Text Sources

Medical