End-of-life practices in European intensive care units - The ethicus study
End-of-life practices in European intensive care units - The ethicus study
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DOI：
10.1001/jama.290.6.790
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发表时间：
2003-08-13
影响因子：
120.7
通讯作者：
Woodcock, T
中科院分区：
文献类型：
--
作者：
Sprung, CL;Cohen, SL;Woodcock, T
虽然实践指南的采用正在使患者护理的许多方面标准化，由于在重症监护中放弃维持生命的治疗，伦理困境正在发生，并且在不同的国家和文化中以不同的方式处理。目的确定欧洲重症监护病房（ICU）中实际临终实践的频率和类型。并分析其异同点。设计与设置一个前瞻性的，欧洲ICU的观察性研究。参与者死亡或有任何治疗限制的连续性患者。干预计划定义的结束-从1999年1月1日至6月30日，对17个欧洲国家37个ICU的生活实践进行了研究，2000年.主要结果测量比较和分析的频率和模式的结束-结果在31417例ICU患者中，4248例（13.5%）患者死亡或生命维持治疗受限。其中，3086例患者（72.6%）有治疗限制（10%的入院）。各国之间在死亡的限制和方式方面存在很大差异：20%心肺复苏不成功（范围，5%-48%），脑死亡8%（范围，0%-15%），38%的患者停止治疗（范围，16%-70%），停止治疗33%（范围，5%-69%），主动缩短死亡过程2%（范围，0%-19%）。7个国家报告缩短了染色过程。据报告，用于缩短死亡过程的阿片类药物和苯二氮卓类药物的剂量范围与既往研究中用于缓解症状的剂量范围相同。限制治疗与继续生命维持治疗与患者年龄、急性和慢性诊断、ICU天数、地区和宗教有关（P
Context While the adoption of practice guidelines is standardizing many aspects of patient care, ethical dilemmas are occurring because of forgoing life-sustaining therapies in intensive care and are dealt with in diverse ways between different countries and cultures.Objectives To determine the frequency and types of actual end-of-life practices in European intensive care units (ICUs) and to analyze the similarities and differences.Design and Setting A prospective, observational study of European ICUs.Participants Consecutive patients who died or had any limitation of therapy.Intervention Prospectively defined end-of-life practices in 37 ICUs in 17 European countries were studied from January 1, 1999, to June 30, 2000.Main Outcome Measures Comparison and analysis of the frequencies and patterns of end-of-life care by geographic regions and different patients and professionals.Results Of 31417 patients admitted to ICUs, 4248 patients (13.5%) died or had a limitation of life-sustaining therapy. Of these, 3086 patients (72.6%) had limitations of treatments (10% of admissions). Substantial intercountry variability was found in the limitations and the manner of dying: unsuccessful cardiopulmonary resuscitation in 20% (range, 5%-48%), brain death in 8% (range, 0%-15%), withholding therapy in 38% (range, 16%-70%), withdrawing therapy in 33% (range, 5%-69%), and active shortening of the dying process in 2% (range, 0%-19%). Shortening of the dying process was reported in 7 countries. Doses of opioids and benzodiazepines reported for shortening of the dying process were in the same range as those used for symptom relief in previous studies. Limitation of therapy vs continuation of life-sustaining therapy was associated with patient age, acute and chronic diagnoses, number of days in ICU, region, and religion (P