Impact of Palliative Care Consultation on Clinical Interventions and Outcomes in a Medical-Surgical Community-Based...

Integrating palliative care into intensive care unit (ICU) practice is an essential component of comprehensive patient management, ensuring that critical interventions are aligned with patient-centered care objectives. This study aims to evaluate the impact of palliative care consultation (PCC) on clinical interventions, patient outcomes, and decision-making processes in a community-based medical-surgical ICUs.

We conducted a prospective, observational, single-center cohort study of critically ill adult patients in a community-based medical-surgical ICU. Patients were grouped by the presence (PCCP) or absence (PCCA) of palliative care consultation. Primary outcomes included differences in clinical interventions (mechanical ventilation, vasoactive medications, renal replacement therapy, family meetings, code status changes, pain management, and comfort care directives). Secondary outcomes included ICU clinical course (Sequential Organ Failure Assessment (SOFA) score at 72 hours, length of ICU/hospital stay, ICU readmission, discharge disposition). Logistic regression was used to identify predictors for PCC involvement.

Of 387 patients included, 27.6% (n = 107) received PCC. The PCCP group exhibited significantly higher use of non-invasive (46.7% vs 27.5%, P < .001) and invasive mechanical ventilation (62.6% vs 28.6%, P < .001), vasoactive medications (37.4% vs 20.4%, P < .05), and renal replacement therapy (9.3% vs 3.2%, P < .05). Additionally, PCCP patients more frequently underwent family meetings within 72 hours (75% vs 62.6%, P < .05), adopted DNR status (46.7% vs 7.9%, P < .001), and transitioned to comfort care and palliative extubation measures. Multivariate analysis identified higher SOFA scores within 24 hours of admission (odds ratio (OR) 1.16; 95% confidence interval (CI) 1.05-1.28) and age 85 or older (OR 0.19; 95% CI 0.05-0.72) as independent predictors of PCC involvement.

Palliative care consultations in critically ill patients are associated with intensified clinical interventions, increased morbidity and mortality, and more frequent discussions regarding advanced directives and comfort-oriented care measures in a community-based mixed ICU. Future research should further elucidate the impact of PCC on patient and family satisfaction within ICU contexts.