GuidelineIntensive care medicine2014
Palliative care in the ICU: relief of pain, dyspnea, and thirst--a report from the IPAL-ICU Advisory Board.
Guideline in Intensive care medicine, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 63 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Treatment of Dyspnea in Do-not-intubate (DNI) Patients
Effect of Implementing Nursing Care on Breathing Discomfort and Its Outcomes Among Mechanically Ventilated Patients
Who cites it
63 citing papers in PubMed, 2 syntheses or guidelines pooled it.
- Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review.Intensive care medicine · 2024Pooled it
- Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis.Intensive care medicine · 2020Pooled it
- Low dose of morphine to relieve dyspnea in acute respiratory failure: the OpiDys double-blind randomized controlled trial.Respiratory research · 2024Trial
- End-of-life decision-making in very old critically ill patients.European geriatric medicine · 2026Review
- Key characteristics of palliative care integration in intensive care units (ICUs): A scoping review.International journal of nursing studies advances · 2026Review
- Oral findings in intensive care unit patients.Medicina oral, patologia oral y cirugia bucal · 2026Article
- Article
- Thirst in End-Stage Liver Disease: From Symptom Disregard to a Multidisciplinary Clinical Pathway and Future Perspectives: A Narrative Review.Journal of multidisciplinary healthcare · 2026Review
- Foundational principles for young intensivists to drive better outcomes: palliative care.Critical care science · 2026Article
- A "PalliPulm" framework to improve palliative care education and practice in pulmonary-critical care medicine: an official American Thoracic Society Workshop Report.Annals of the American Thoracic Society · 2026Article
- Impact of closed-system suctioning on self-reported dyspnea in mechanically ventilated patients: a prospective observational study.Frontiers in medicine · 2026Article
- Study protocol testing feasibility of the Comfort Measures Only Time out (CMOT) to reduce distress during palliative withdrawal of mechanical ventilation.Pilot and feasibility studies · 2025Article
- Self-reported symptoms in ICU patients and their impact on long-term outcomes-a prospective multicenter study.Intensive care medicine · 2025Article
- Observational
- Construction of an assessment scale for thirst severity in critically ill patients and its reliability and validity.Journal of clinical nursing · 2025Article
- Translation and Cross-Cultural Adaptation of The Cancer Dyspnoea Scale - CDS into Brazilian Portuguese.CoDAS · 2025Article
- Impact of a Comprehensive Palliative Quality Improvement Initiative (ICU-PAL) in a Medical-Surgical Intensive Care Unit.HCA healthcare journal of medicine · 2025Article
- Caring for the dying patient in ICU.Intensive care medicine · 2024Article
- Critical care beyond organ support: the importance of geriatric rehabilitation.Annals of intensive care · 2024Review
- Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
3 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
16 authors.
Funding
Abstract
purposePain, dyspnea, and thirst are three of the most prevalent, intense, and distressing symptoms of intensive care unit (ICU) patients. In this report, the interdisciplinary Advisory Board of the Improving Palliative Care in the ICU (IPAL-ICU) Project brings together expertise in both critical care and palliative care along with current information to address challenges in assessment and management.
methodsWe conducted a comprehensive review of literature focusing on intensive care and palliative care research related to palliation of pain, dyspnea, and thirst.
resultsEvidence-based methods to assess pain are the enlarged 0-10 Numeric Rating Scale (NRS) for ICU patients able to self-report and the Critical Care Pain Observation Tool or Behavior Pain Scale for patients who cannot report symptoms verbally or non-verbally. The Respiratory Distress Observation Scale is the only known behavioral scale for assessment of dyspnea, and thirst is evaluated by patient self-report using an 0-10 NRS. Opioids remain the mainstay for pain management, and all available intravenous opioids, when titrated to similar pain intensity end points, are equally effective. Dyspnea is treated (with or without invasive or noninvasive mechanical ventilation) by optimizing the underlying etiological condition, patient positioning and, sometimes, supplemental oxygen. Several oral interventions are recommended to alleviate thirst. Systematized improvement efforts addressing symptom management and assessment can be implemented in ICUs.
conclusionsRelief of symptom distress is a key component of critical care for all ICU patients, regardless of condition or prognosis. Evidence-based approaches for assessment and treatment together with well-designed work systems can help ensure comfort and related favorable outcomes for the critically ill.
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What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.