• Victoria Metaxa, Despina Anagnostou, Savvas Vlachos, Nishkantha Arulkumaran, Sherihane Bensemmane, Ingeborg van Dusseldorp, Rebecca A Aslakson, Judy E Davidson, Rik T Gerritsen, Christiane Hartog, and CurtisJ RandallJRDivision of Pulmonary, Critical Care and Sleep Medicine, Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA..
• King's College Hospital, London, SE5 9RS, UK. victoria.metaxa@nhs.net.
• Intensive Care Med. 2021 Dec 1; 47 (12): 1415-1425.

PurposeThe integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear.MethodsWe conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries.ResultsFifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies.ConclusionBeneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.© 2021. Springer-Verlag GmbH Germany, part of Springer Nature.

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