Prospective study of a proactive palliative care rounding intervention in a medical ICU.
Prospective study of a proactive palliative care rounding intervention in a medical ICU.
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DOI：
10.1007/s00134-015-4098-1
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发表时间：
2016-01
影响因子：
38.9
通讯作者：
Ehlenbach WJ
中科院分区：
文献类型：
--
作者：
Braus N;Campbell TC;Kwekkeboom KL;Ferguson S;Harvey C;Krupp AE;Lohmeier T;Repplinger MD;Westergaard RP;Jacobs EA;Roberts KF;Ehlenbach WJ
评估姑息治疗干预对临床和家庭结局以及姑息治疗过程的影响。在24张病床的学术重症监护病房(ICU)进行前瞻性、事前和事后的干预研究，纳入有高死亡率、发病率或未满足姑息治疗需求的患者。干预包括一名姑息治疗临床医生与ICU医生互动，为高危患者进行每日查房。100名患者进入常规护理阶段，103名患者进入干预阶段。调整后在ICU举行家庭会议的可能性增加了63%(RR1.63，95%可信区间1.14比2.07，P=0.01)，家庭会议时间缩短了41%(95%可信区间52%比28%，P<；0.001)。调整后的ICU住院时间(LOS)在两组间无显著差异(6%缩短，95%可信区间缩短16%，4%延长，p=0.22)。在那些在医院死亡的患者中，ICU LOS在干预中缩短了19%(95%可信区间为33%，缩短了1%，p=0.043)。干预后，调整后的医院LOS缩短了26%(95%可信区间缩短31%至20%，p<；0.001)。干预期间9.1%的家庭受访者出现创伤后应激障碍症状，干预前为20.7%(p=0.09)。死亡率、家庭抑郁症状、家庭满意度以及死亡和临终质量在两组之间没有显著差异。对于高危患者，积极参与ICU查房的姑息治疗与更多更早的ICU家庭会议和更短的住院时间相关。我们没有发现家庭满意度、家庭心理症状或家庭评定的死亡质量方面的差异，但发现这些差异的能力有限。
To evaluate the effects of a palliative care intervention on clinical and family outcomes, and palliative care processes. Prospective, before-and-after interventional study enrolling patients with high risk of mortality, morbidity, or unmet palliative care needs in a 24-bed academic intensive care unit (ICU). The intervention involved a palliative care clinician interacting with the ICU physicians on daily rounds for high-risk patients. 100 patients were enrolled in the usual care phase, and 103 patients were enrolled during the intervention phase. The adjusted likelihood of a family meeting in ICU was 63% higher (RR 1.63, 95% CI 1.14 to 2.07, p=0.01), and time to family meeting was 41% shorter (95% CI 52% to 28% shorter, p<0.001). Adjusted ICU length of stay (LOS) was not significantly different between the two groups (6% shorter, 95% CI 16% shorter to 4% longer, p=0.22). Among those who died in the hospital, ICU LOS was 19% shorter in the intervention (95% CI 33% to 1% shorter, p=0.043). Adjusted hospital LOS was 26% shorter (95% CI 31% to 20% shorter, p < 0.001) with the intervention. PTSD symptoms were present in 9.1% of family respondents during the intervention versus 20.7% prior to the intervention (p=0.09). Mortality, family depressive symptoms, family satisfaction and quality of death and dying did not significantly differ between groups. Proactive palliative care involvement on ICU rounds for high-risk patients was associated with more and earlier ICU family meetings and shorter hospital LOS. We did not identify differences in family satisfaction, family psychological symptoms, or family-rated quality of dying, but had limited power to detect such differences.