Surviving intensive care: a report from the 2002 Brussels Roundtable
Surviving intensive care: a report from the 2002 Brussels Roundtable
复制标题
DOI：
10.1007/s00134-002-1624-8
复制
发表时间：
2003-03-01
影响因子：
38.9
通讯作者：
Carlet, J
中科院分区：
文献类型：
--
作者：
Angus, DC;Carlet, J
重症监护的传统目标是降低短期死亡率。虽然这个目标是值得的，但它未能解决重症监护生存意味着什么的问题。关键问题包括重症监护幸存者是否有最佳的长期结果，以及如果我们更多地了解这些结果，ICU护理决策是否会改变。2002年布鲁塞尔圆桌会议“重症监护的幸存者”强调了这些问题，总结了关于危重病自然史和风险因素的现有证据，并概述了未来的护理和研究方向。危重病与一系列严重和令人担忧的长期后遗症相关，这些后遗症干扰了以患者为中心的最佳结局。虽然传统的短期结局（如住院死亡率）仍然非常重要，但它们不太可能成为随后以患者为中心的结局的适当替代品。因此，重要的是要特别关注危重病和重症监护如何影响病人和亲属的长期健康和福祉。有大量的潜在的前，内，和后ICU的因素，可能会改善或恶化这些结果，这些因素是未来的研究课题。此外，未来ICU治疗的临床试验应包括长期随访生存率、生活质量、发病率、功能状态和护理费用。随访期至少为6个月。SF-36和EuroQOL EQ-5D是多中心重症监护试验中测量生活质量的最佳工具，但鼓励进行进一步的方法学研究和工具设计。今天也有机会改善护理。利用这些机会的关键是需要全球意识到危重病是一个在ICU“盒子”之外开始和结束的实体。显示出改善护理前景的具体干预措施包括ICU出院筛查工具和ICU随访诊所。
The traditional goal of intensive care has been to decrease short-term mortality. While worthy, this goal fails to address the issue of what it means to survive intensive care. Key questions include whether intensive care survivors have optimal long-term outcomes and whether ICU care decisions would change if we knew more about these outcomes. The 2002 Brussels Roundtable, "Surviving Intensive care", highlighted these issues, summarizing the available evidence on natural history and risk factors for critical illness and outlining future directions for care and research. Critical illness is associated with a wide array of serious and concerning longterm sequelae that interfere with optimal patient-centered outcomes. Although traditional short-term Outcomes, such as hospital mortality, remain extremely important, they are not likely to be adequate surrogates for subsequent patient-centered outcomes. As such, it is important to focus specifically on how critical illness and intensive care affects a patient's and relatives' long-term health and well-being. There are a large number of potential pre-, intra-, and post-ICU factors that may improve or worsen these outcomes, and these factors are subjects for future research. In addition, future clinical trials of ICU therapies should include long-term follow-up of survival, quality of life, morbidity, functional status, and costs of care. Follow-up ought to be for at least six months. The SF-36 and EuroQOL EQ-5D are the best-suited instruments for measuring quality of life in multicenter critical care trials though further methodologic research and instrument design is encouraged. There are also opportunities today to improve care. Key to taking advantage of such opportunities is the need for a global awareness of critical illness as an entity that begins and ends outside the ICU 'box'. Specific interventions that show promise for improving care include ICU discharge screening tools and ICU follow-up clinics.