Taking a Chance to Recover: Families Look Back on the Decision to Pursue Tracheostomy After Severe Acute Brain Injury.
Taking a Chance to Recover: Families Look Back on the Decision to Pursue Tracheostomy After Severe Acute Brain Injury.
复制标题
DOI：
10.1007/s12028-021-01335-9
复制
发表时间：
2022-04
影响因子：
3.5
通讯作者：
Creutzfeldt CJ
中科院分区：
文献类型：
--
作者：
Lou W;Granstein JH;Wabl R;Singh A;Wahlster S;Creutzfeldt CJ
气管切开术是严重急性脑损伤(SABI)后一项重要且有价值的治疗决定。是否继续这种维持生命的治疗通常取决于家庭和临床医生之间的激烈对话。这项研究的目的是，在一组SABI后接受气管切开的患者中，探索患者及其家人在回顾这一决定时的长期反思。在这项定性研究中，我们回顾了接受气管切开术的沙比氏症患者的电子病历。我们纳入了2017年11月至2019年10月期间住进我们有30张床位的神经重症监护病房的所有患者，并接受了气管切开术。使用有目的的抽样，我们邀请幸存者和家人参加萨比事件后3个月以上的电话采访，直到主题达到饱和。访谈被录音、转录，并使用主题分析进行分析。总体而言，神经重症监护病房中的38名Sabi患者接受了气管切开术。患者的平均年龄为49岁(范围18-81岁)，其中19名患者被诊断为创伤性脑损伤，19名患者被诊断为中风。我们在住院后平均16个月(SD 9)采访了38名患者中18名患者的20名家属。接受面谈的患者的平均年龄为50岁(范围18-76)；出院时的平均改良Rankin量表评分(MRS)为4.7(SD 0.8)。在访谈时，10名患者住在家里，2名患者住在熟练的护理机构，平均MRS为2.6(SD 0.9)，6名患者已经死亡。随着家庭对继续进行气管切开术的决定进行反思，出现了两个主题。首先，家庭不记得气管切开术是一种选择，因为康复的不确定机会使死亡的某些替代方案不可接受，或者因为他们把生存放在最重要的位置，因此无法意识到除了维持生命的治疗之外还有其他选择。其次，家庭认为需要得到以同情、清晰和希望为中心的支持性、始终如一的沟通。当这一需求得到满足时，家庭能够平静地反思气管切开术的决定，无论他们所爱的人最终的结果如何。在萨比之后，预测的不确定性几乎超越了选择的概念。进行气管切开术的家庭认为这是当时唯一的选择。高质量的沟通可能会缓解围绕这一高风险决策的压力。网上版载有补充材料，可在10.1007/s12028-021-01335-9查阅。
Tracheostomy represents one important and value-laden treatment decision after severe acute brain injury (SABI). Whether to pursue this life-sustaining treatment typically hinges on intense conversations between family and clinicians. The aim of this study was, among a cohort of patient who had undergone tracheostomy after SABI, to explore the long-term reflections of patients and their families as they look back on this decision. For this qualitative study, we reviewed the electronic medical records of patients with SABI who underwent tracheostomy. We included all patients who were admitted to our 30-bed neuro-intensive care unit with SABI and underwent tracheostomy between November 2017 and October 2019. Using purposive sampling, we invited survivors and family members to participate in telephone interviews greater than 3 months after SABI until thematic saturation was reached. Interviews were audiotaped, transcribed, and analyzed by using thematic analysis. Overall, 38 patients with SABI in the neuro-intensive care unit underwent tracheostomy. The mean age of patients was 49 (range 18–81), with 19 of 38 patients diagnosed with traumatic brain injury and 19 of 38 with stroke. We interviewed 20 family members of 18 of 38 patients at a mean of 16 (SD 9) months after hospitalization. The mean patient age among those with an interview was 50 (range 18–76); the mean modified Rankin Scale score (mRS) was 4.7 (SD 0.8) at hospital discharge. At the time of the interview, ten patients lived at home and two in a skilled nursing facility and had a mean mRS of 2.6 (SD 0.9), and six had died. As families reflected on the decision to proceed with a tracheostomy, two themes emerged. First, families did not remember tracheostomy as a choice because the uncertain chance of recovery rendered the certain alternative of death unacceptable or because they valued survival above all and therefore could not perceive an alternative to life-sustaining treatment. Second, families identified a fundamental need to receive supportive, consistent communication centering around compassion, clarity, and hope. When this need was met, families were able to reflect on the tracheostomy decision with peace, regardless of their loved one’s eventual outcome. After SABI, prognostic uncertainty almost transcends the concept of choice. Families who proceeded with a tracheostomy saw it as the only option at the time. High-quality communication may mitigate the stress surrounding this high-stakes decision. The online version contains supplementary material available at 10.1007/s12028-021-01335-9.
登录
查看更多内容
影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
3.5
作者：
Krishnamoorthy, Vijay;Hough, Catherine L.;Creutzfeldt, Claire J.
通讯作者：
Creutzfeldt, Claire J.
影响因子：
4.4
作者：
Epstein, Ronald M.;Street, Richard L., Jr.
通讯作者：
Street, Richard L., Jr.
影响因子：
2.6
作者：
Kuehlmeyer, Katja;Palmour, Nicole;Racine, Eric
通讯作者：
Racine, Eric
影响因子：
2.8
作者：
Schutz, Rachael E. C.;Coats, Heather L.;Creutzfeldt, Claire J.
通讯作者：
Creutzfeldt, Claire J.