Palliative Care in Neurocritical Care

Patients suffering from devastating brain injuries (DBI)—severe traumatic brain injury, ruptured aneurysmal subarachnoid hemorrhage, intracerebral hemorrhage, and acute ischemic stroke—are at high risk of morbidity and mortality, are often subject to unclear prognostication, and are frequently unable to participate in shared medical decision-making, placing considerable stress on families. Palliative care services have been shown to positively address pain management, provider-patient communication, and overall interactions with staff and improve families’ satisfaction with a patient’s experience. Palliative care consultation can decrease ICU length of stay (LOS) without affecting mortality. Unique issues for palliative care in neuro-intensive care unit: devastated condition/catastrophic presentation, substantial uncertainty about quality of life, and communication difficulty. After proper prognostication, palliative care should be discussed with relatives. GRIEV_ING is a tool used to ensure successful information transfer and empathic communication with the family members opting for palliative care. Patient and family-centered goals of treatment are the center of palliative care plan. Strategies to help ensure the delivery of appropriate and optimal patient-centered care for patients at high risk of death or severe disability should be undertaken to overcome the barriers in palliative care.