The symptom burden of chronic critical illness
The symptom burden of chronic critical illness
复制标题
DOI：
10.1097/01.ccm.0000129485.08835.5a
复制
发表时间：
2004-07-01
影响因子：
8.8
通讯作者：
Morrison, RS
中科院分区：
文献类型：
--
作者：
Nelson, JE;Meier, DE;Morrison, RS
Objective.评估慢性危重病的自我报告症状负担。设计：前瞻性队列研究。设置。在一个学术、三级护理、城市医疗中心治疗慢性危重病患者的呼吸监护病房。患者：50名患者接受了选择性气管切开术，并从成人重症监护病房转移到呼吸监护病房以脱离机械通气。通过患者的自我报告，使用修订的浓缩形式的记忆症状评估Scale.Measurements和主要结果的身体和心理症状的评估：我们测量了自我报告的症状负担，呼吸机的结果，以及出院时和出院后3个月和6个月的生命状态和功能状态。一半的患者成功地从机械通气中解脱出来，但大多数医院幸存者出院到熟练的护理机构，超过一半的患者在出院后3个月死亡。72%（36/50）的患者在呼吸监护室治疗期间能够自我报告症状。在对症状评估有反应的患者中，约90%有症状。44%的患者报告疼痛程度最高。超过60%的心理症状，在这些水平，约90%的患者报告严重的困扰，由于难以communication.Conclusions：生理和心理症状困扰是常见的，严重的慢性危重病患者接受治疗。这些患者大多数在出院后不久死亡。考虑到我们研究患者的痛苦程度以及我们和其他人观察到的高死亡率，应更加关注缓解疼痛和其他痛苦症状，并评估慢性危重病患者治疗的负担和益处。
Objective. To assess self-reported symptom burden of chronic critical illness.Design: Prospective cohort study.Setting. Respiratory care unit for treatment of chronically critically ill patients at an academic, tertiary-care, urban medical center.Patients: Fifty patients who underwent elective tracheotomy and transfer from an adult intensive care unit to the respiratory care unit for weaning from mechanical ventilation.Interventions. Assessment of physical and psychological symptoms through patients' self-reports using a modification of the Condensed Form of the Memorial Symptom Assessment Scale.Measurements and Main Results: We measured self-reported symptom burden, ventilator outcomes, and vital status and functional status at discharge and 3 and 6 months after discharge. Half of the patients were successfully liberated from mechanical ventilation, but most hospital survivors were discharged to skilled nursing facilities and more than half of the cohort was dead at 3 months after discharge. Seventy-two percent (36 of 50) of patients were able to self-report symptoms during the period of respiratory care unit treatment. Among patients responding to symptom assessment, approximately 90% were symptomatic. Forty-four percent of patients reported pain at the highest levels. More than 60% reported psychological symptoms at these levels, and approximately 90% of patients reported severe distress due to difficulty communicating.Conclusions: Physical and psychological symptom distress is common and severe among patients receiving treatment for chronic critical illness. The majority of these patients die soon after hospital discharge. Given the level of distress in our study patients and the high mortality rate that we and others have observed, greater attention should be given to relief of pain and other distressing symptoms and to assessment of burdens and benefits of treatment for the chronically critically ill.