Critical Care 2 Ethics and end-of-life care for adults in the intensive care unit
Critical Care 2 Ethics and end-of-life care for adults in the intensive care unit
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DOI：
10.1016/s0140-6736(10)60143-2
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发表时间：
2010-10-16
期刊：
影响因子：
168.9
通讯作者：
Vincent, Jean-Louis
中科院分区：
文献类型：
--
作者：
Curtis, J. Randall;Vincent, Jean-Louis
重症监护病房（ICU）是给病人提供一些技术最先进的维持生命治疗的地方，也是对这些治疗是否有用做出艰难决定的地方。这些伦理决定的重大区域差异是许多因素的结果，包括宗教和文化信仰。由于大多数危重患者缺乏做决定的能力，家庭和其他个人经常充当替代决策者，在许多地区，临床医生和家庭之间的沟通是ICU决策的核心。在其他地方，家庭的参与减少了，医生的参与增加了。临终关怀与在ICU工作的临床医生的倦怠和痛苦增加有关。由于ICU的许多死亡都是在决定保留或撤回生命支持之前发生的，因此高质量的决策和临终关怀在所有地区都是至关重要的，可以改善患者和家庭的结果，并保留在ICU工作的临床医生。要做出这样的决定，需要充分的培训，临床医生和家庭之间的良好沟通，以及一个运作良好的跨学科团队的合作。
The intensive care unit (ICU) is where patients are given some of the most technologically advanced life-sustaining treatments, and where difficult decisions are made about the usefulness of such treatments. The substantial regional variability in these ethical decisions is a result of many factors, including religious and cultural beliefs. Because most critically ill patients lack the capacity to make decisions, family and other individuals often act as the surrogate decision makers, and in many regions communication between the clinician and family is central to decision making in the ICU. Elsewhere, involvement of the family is reduced and that of the physicians is increased. End-of-life care is associated with increased burnout and distress among clinicians working in the ICU. Since many deaths in the ICU are preceded by a decision to withhold or withdraw life support, high-quality decision making and end-of-life care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU. To make such a decision requires adequate training, good communication between the clinician and family, and the collaboration of a well functioning interdisciplinary team.