Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios.
Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios.
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DOI：
10.1186/cc9390
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Deheinzelin D
中科院分区：
文献类型：
--
作者：
Fumis RR;Deheinzelin D
有证据表明，重症监护病房中临终患者的身体和精神痛苦没有得到充分治疗。尽管有关于放弃生命维持治疗的决定的建议，但撤回生命支持的决定很困难，而且也很难决定谁应该参与这一决定。我们在 13 个成人重症监护病房 (ICU) 中分发了一份自填问卷，评估医生和护士对临终决策的态度。来自三级肿瘤医院内外科ICU的家属也受邀参加。问题涉及两种假设的临床场景，一种是有能力的患者，另一种是无能力的患者，询问是否应该撤回呼吸机治疗以及谁应该做出这个决定。 12 个 ICU 的医生（155 名）和护士（204 名）以及 300 名家属同意参加这项研究。绝大多数家庭（78.6%）、医生（74.8%）和护士（75%）希望与有能力的患者讨论临终决定。大多数医生和护士希望家人参与临终决策。对于有能力的患者，医生比对无能力的患者更有可能建议撤除呼吸机（74.8% × 60.7%，P = 0.028）。当患者无能力时，医生（34.8%）比护士（23.0%）和家属（14.7%）更不容易提出有关撤回呼吸机支持的决定（P < 0.001）。医生、护士和家属建议限制对绝症患者的生命支持治疗，并支持家庭参与。在涉及无能力患者的决定时，医生更有可能维持治疗。
Evidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision. We distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision. Physicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001). Physicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy.
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影响因子：
38.9
作者：
Carlet, J;Thijs, LG;Thompson, BT
通讯作者：
Thompson, BT
影响因子：
38.9
作者：
Giannini, A;Pessina, A;Tacchi, EM
通讯作者：
Tacchi, EM
DOI：
10.1164/ajrccm.155.1.9001282
发表时间：
1997-01-01
影响因子：
24.7
作者：
Prendergast, TJ;Luce, JM
通讯作者：
Luce, JM
影响因子：
38.9
作者：
Lins Fumis, Renata Rego;Deheinzelin, Daniel
通讯作者：
Deheinzelin, Daniel
DOI：
10.1097/01.pcc.0000154958.71041.37
发表时间：
2005-05-01
期刊：
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
影响因子：
--
作者：
Kipper, Delio Jose;Piva, Jefferson Pedro;Morais, Joao Feliz Duarte
通讯作者：
Morais, Joao Feliz Duarte