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Minimally Invasive Endoscopic Intracerebral Hemorrhage Evacuation
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Intracerebral hemorrhage for the palliative care provider: what you need to know

B Brent Simmons1, Susan M Parks

  • 1Section of Geriatric Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania, USA. b.brent.simmons@tuhs.temple.edu

Journal of Palliative Medicine
|January 1, 2009
PubMed

Insights

Palliative care is crucial for intracerebral hemorrhage (ICH) patients, aiding goal development and prognosis assessment. Discussing do-not-resuscitate (DNR) status and holding family meetings are vital for end-of-life care planning.

Area of Science:

  • Neurology
  • Palliative Care
  • Critical Care Medicine

Background:

  • Intracerebral hemorrhage (ICH) accounts for 10%-30% of all strokes.
  • Palliative care involvement is essential for managing ICH cases and developing patient goals.
  • Prognostic scores like ICH and Essen aid in predicting outcomes.

Purpose of the Study:

  • To outline the role of palliative care in intracerebral hemorrhage management.
  • To discuss prognostic indicators and do-not-resuscitate (DNR) status discussions.
  • To detail end-of-life care interventions and the importance of family meetings.

Main Methods:

  • Review of prognostic scoring systems (ICH score, Essen score).
  • Discussion of expert consensus on DNR status appropriateness.
  • Description of end-of-life care practices, including ventilatory support withdrawal and symptom management.
  • Emphasis on the role and impact of family meetings.

Main Results:

  • ICH score and Essen score aid in prognosis calculation.
  • DNR status is recommended with severe stroke, brain damage, or comorbidities.
  • Most ICH patients die within 24 hours post-extubation.
  • Family meetings facilitate timely decisions regarding life support withdrawal (66% within 24 hours).

Conclusions:

  • Palliative care providers play a key role in ICH management.
  • Prognostication, DNR discussions, and family meetings are critical components of end-of-life care for ICH patients.
  • Effective communication and symptom management improve the dying process for ICH patients and their families.

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