Outcomes of palliative care consultation in patients with ESRD who received cardiopulmonary resuscitation.
Outcomes of palliative care consultation in patients with ESRD who received cardiopulmonary resuscitation.
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DOI：
10.5414/cn110096
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发表时间：
2021-07
影响因子：
1.1
通讯作者：
Saeed F
中科院分区：
文献类型：
--
作者：
Hsu CM;Murad H;Neuendorf K;Gao T;Schold JD;Saeed F
背景：大多数透析患者在临终时接受积极、繁重的治疗。目前，我们缺乏改善这些患者临终关怀 (EoLC) 的干预措施。我们研究了姑息治疗咨询与接受心肺复苏 (CPR) 的终末期肾病 (ESRD) 危重患者的 EoLC 改善之间的关系。材料和方法：在这项回顾性研究中，我们纳入了一家大型学术中心收治的 ESRD 患者，他们在住院前或住院期间接受了心肺复苏。 8年来，403名患者中有17名在住院期间接受了姑息治疗咨询；磋商的内容没有标准化。更好地实施 EoLC 的主要结果是：(1) 代码状态从完整代码更改为不复苏 (DNR) 和 (2) 退出重症监护。结果：在研究的患者中，60.5% 是非裔美国人，43.2% 是女性。接受姑息治疗咨询的患者与接受常规护理的患者之间的人口统计学差异没有统计学意义。对于接受 CPR 的 ESRD 患者，姑息治疗咨询与 DNR 代码状态变化（比值比 8.10，95% 置信区间 2.19 – 29.94）和退出重症监护（比值比 8.82，95% 置信区间 2.69 – 28.91）的几率较高相关。姑息治疗咨询与院内死亡率的任何变化无关。结论：对于预期预后有限的住院 ESRD 患者，需要考虑姑息治疗咨询，因为它可能会减少临终时的积极和繁重的治疗。此外，应向肾科医生传授沟通和决策等初级姑息治疗技能，以改善透析患者的 EoLC。
Background: The majority of dialysis patients receive aggressive burdensome treatment near the end of life. Currently, we lack interventions to improve end-of-life care (EoLC) for these patients. We examined the association of palliative care consultation with improving EoLC for critically ill patients with end-stage renal disease (ESRD) who received cardiopulmonary resuscitation (CPR). Materials and methods: In this retrospective study, we included patients with ESRD admitted to a large academic center who received CPR either prior to or during their hospital stay. Over 8 years, 17 out of 403 patients received palliative care consultation during their hospital stay; consultations were not standardized in their content. Main outcomes of interest to operationalize better EoLC were: (1) change in code status from full code to do not resuscitate (DNR) and (2) withdrawal from intensive care. Results: Of the patients studied, 60.5% were African-American and 43.2% were female. Demographic differences between those with palliative care consultation and those with usual care were not statistically significant. Palliative care consultation was associated with higher odds of change in code status to DNR (odds ratio 8.10, 95% confidence interval 2.19 – 29.94) and withdrawal from intensive care (odds ratio 8.82, 95% confidence interval 2.69 – 28.91) in patients with ESRD who had received CPR. Palliative care consultation was not associated with any change in in-hospital mortality. Conclusion: Palliative care consultation needs to be considered for hospitalized ESRD patients with limited expected prognoses as it may reduce aggressive and burdensome therapies at the end of life. Furthermore, primary palliative care skills such as communication and decision-making should be taught to nephrologists to improve EoLC for dialysis patients.