Epidemiology of Death in the PICU at Five US Teaching Hospitals
Epidemiology of Death in the PICU at Five US Teaching Hospitals
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DOI：
10.1097/ccm.0000000000000498
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发表时间：
2014-09-01
影响因子：
8.8
通讯作者：
Truog, Robert D.
中科院分区：
文献类型：
--
作者：
Burns, Jeffrey P.;Sellers, Deborah E.;Truog, Robert D.
目的：为了确定在PICU死亡的流行病学在5个地理上不同的教学医院在美国各地设计：前瞻性病例系列。设置：五个美国教学hospitals.Subjects：我们同时确定了192个连续的患者谁死之前从PICU出院。每家临床试验机构入组了24 - 50例患者。每个PICU有相似的组织和人员结构。干预措施：无。测量和主要结果：总死亡率为2.39%（范围，1.85-3.38%）。133名患者（70%）在暂停或停止生命维持治疗后死亡，30名（16%）被诊断为脑死亡，26名（14%）在复苏尝试失败后死亡。57%的死亡发生在入院后的第一周内;这些患者更有可能患有新发疾病或受伤，其中包括大多数在心肺复苏尝试失败或脑死亡诊断后死亡的患者。在PICU住院超过1周后死亡的患者更有可能有预先存在的诊断，入院前对技术有依赖性，并且在停止维持生命的治疗后死亡。只有64%的患者死亡后扣留或撤回的生命支持有一个正式的不复苏秩序，在他们的death.Conclusions：在PICU的死亡模式是按比例相似的报告，在过去的二十年中，而死亡率几乎减半。死亡的主要特征是两个相当不同的配置文件，与死亡是否发生在1周内或超过1周的住院时间。不复苏的决定往往是在没有正式的不复苏令的情况下作出的。这些数据对未来的质量改进计划有影响，特别是在姑息治疗、临终决策和器官捐赠方面。
Objective: To determine the epidemiology of death in PICUs at 5 geographically diverse teaching hospitals across the United States.Design: Prospective case series.Setting: Five U.S. teaching hospitals.Subjects: We concurrently identified 192 consecutive patients who died prior to discharge from the PICU. Each site enrolled between 24 and 50 patients. Each PICU had similar organizational and staffing structures.Interventions: None.Measurements and Main Results: The overall mortality rate was 2.39% (range, 1.85-3.38%). One hundred thirty-three patients (70%) died following the withholding or withdrawal of life-sustaining treatments, 30 (16%) were diagnosed as brain dead, and 26 (14%) died following an unsuccessful resuscitation attempt. Fifty-seven percent of all deaths occurred within the first week of admission; these patients, who were more likely to have new onset illnesses or injuries, included the majority of those who died following unsuccessful cardiopulmonary resuscitation attempts or brain death diagnoses. Patients who died beyond 1-week length of stay in the PICU were more likely to have preexisting diagnoses, to be technology dependent prior to admission, and to have died following the withdrawal of life-sustaining treatment. Only 64% of the patients who died following the withholding or withdrawing of life support had a formal do-not-resuscitate order in place at the time of their death.Conclusions: The mode of death in the PICU is proportionally similar to that reported over the past two decades, while the mortality rate has nearly halved. Death is largely characterized by two fairly distinct profiles that are associated with whether death occurs within or beyond 1-week length of stay. Decisions not to resuscitate are often made in the absence of a formal do-not-resuscitate order. These data have implications for future quality improvement initiatives, especially around palliative care, end-of-life decision making, and organ donation.