• Jennifer A Frontera, CurtisJ RandallJR, Judith E Nelson, Margaret Campbell, Michelle Gabriel, Anne C Mosenthal, Colleen Mulkerin, Kathleen A Puntillo, Daniel E Ray, Rick Bassett, Renee D Boss, Dana R Lustbader, Karen J Brasel, Stefanie P Weiss, David E Weissman, and Improving Palliative Care in the ICU Project Advisory Board.
• 1Cerebrovascular Center of the Neurological Institute, Cleveland Clinic, Cleveland, OH. 2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Harborview Medical Center, University of Washington, Seattle, WA. 3Departments of Medicine and Anesthesia & Critical Care, Memorial Sloan Kettering Cancer Center, New York, NY. 4College of Nursing, Wayne State University, Detroit, MI. 5Office of Quality, Safety and Value, VA Palo Alto Health Care System, Palo Alto, CA. 6Department of Surgery, Rutgers New Jersey Medical School, Newark, NJ. 7Palliative Medicine and Social Work Services, Hartford Hospital, Hartford, CT. 8Department of Physiological Nursing, University of California, San Francisco, School of Nursing, San Francisco, CA. 9Section of Palliative Medicine and Hospice Medicine, Lehigh Valley Health Network, Allentown, PA. 10St. Luke's Boise Medical Center, Boise, ID. 11Division of Neonatal-Perinatal Medicine, John Hopkins University School of Medicine, Baltimore, MD. 12ProHEALTH, Hofstra North Shore-Long Island Jewish Health System, Lake Success, NY. 13Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Oregon Health and Science University, Portland, OR. 14Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY. 15Medical College of Wisconsin, Milwaukee, WI.
• Crit. Care Med. 2015 Sep 1; 43 (9): 1964-77.

ObjectivesTo describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill.Data SourcesA search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury."Data Extraction And SynthesisWe reviewed the existing literature on delivery of palliative care in the neurointensive care unit setting, focusing on challenges and strategies for establishing realistic and appropriate goals of care, symptom management, organ donation, and other considerations related to use and limitation of life-sustaining therapies for neurocritically ill patients. Based on review of these articles and the experiences of our interdisciplinary/interprofessional expert advisory board, this report was prepared to guide critical care staff, palliative care specialists, and others who practice in this setting.ConclusionsMost neurocritically ill patients and their families face the sudden onset of devastating cognitive and functional changes that challenge clinicians to provide patient-centered palliative care within a complex and often uncertain prognostic environment. Application of palliative care principles concerning symptom relief, goal setting, and family emotional support will provide clinicians a framework to address decision making at a time of crisis that enhances patient/family autonomy and clinician professionalism.

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