Palliative care in the PICU

Pediatric palliative care seeks to treat suffering and achieve the best possible quality of life for patients facing serious or potentially life-limiting illnesses. The goals and values of the child and family should direct decision making and guide care. Curative care may be continued with increased attention to symptom management and the psychosocial needs of the family. Palliative care focuses on six domains: (1) support of the family unit; (2) communication about treatment goals with the child and family; (3) ethics and shared decision making; (4) pain and other symptom relief; (5) care continuity; and 6) grief and bereavement support. After providing a comprehensive palliative care definition and discussion of pediatric intensive care unit (PICU) patients who might benefit from palliative care, this chapter reviews: the integration of palliative care into the PICU, focusing on the six defined domains; the importance of attending to the emotional needs of healthcare professionals; and practical considerations during the peri-death and bereavement periods. This review is intended to aid pediatric intensivists as they treat and guide patients confronted with serious or potentially life-limiting illnesses and their families. By adhering to the principles of palliative care, intensivists assume a privileged role and can positively impact patients, families, and health care professionals during challenging times.