An approach to caring for patients and family of patients dying in the ICU.

TOPIC IMPORTANCE: Death is common in the intensive care unit (ICU), and often occurs after a decision to withhold or withdraw life-sustaining therapies. Care of the dying is a core skill for ICU clinicians, requiring expert communication, primarily with family of critically ill patients.

REVIEW FINDINGS: There is limited high-quality evidence to support specific practices related to the care of dying patients in the ICU, thus many of the recommendations that exist are based on expert opinion. There is value in sharing a practical approach to caring for patients during the dying process, including topics to be addressed with family members, rationales for recommended care, and strategies for implementing comfort measures only. Through dedicated preparation and planning, clinicians can help family members navigate this intense experience.

SUMMARY: Once a decision had been made to discontinue life-sustaining therapies, family members need to be given a clear description of comfort measures only and provided with additional detail about what it entails, including therapies or interventions to be discontinued, monitoring during the dying process, and common features of the dying process. Order sets can be a valuable resource for ensuring adequate analgesia and sedation are available and the care plan is properly enacted. To achieve a good death for patients, a collaborative effort between members of the care team is essential.