High burden of palliative needs among older intensive care unit survivors transferred to post-acute care facilities. a single-center study.
High burden of palliative needs among older intensive care unit survivors transferred to post-acute care facilities. a single-center study.
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DOI：
10.1513/annalsats.201303-039oc
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发表时间：
2013-10-01
影响因子：
8.3
通讯作者：
Bach, Peter
中科院分区：
文献类型：
--
作者：
Baldwin, Matthew R;Wunsch, Hannah;Bach, Peter
基本原理：成人慢性危重病患者（机械通气≥ 10 d后的气管造口术）有很高的姑息治疗需求负担，但对于出院到急性后护理机构的老年重症监护室（ICU）幸存者的实际使用和潜在需求知之甚少。确定出院到急性期后护理机构的老年ICU幸存者是否有潜在未满足的姑息治疗需求。我们检查了228名≥ 65岁的连续成年人的1年队列的电子记录，这些成年人于2009年在一家三级医疗中心首次入住医学ICU，并存活至出院至急性后护理机构（不包括临终关怀）。姑息治疗服务的使用被定义为接受姑息治疗咨询。潜在的姑息治疗需求被定义为患者的特征提示身体或心理症状困扰或预期预后不良。我们研究了潜在的姑息治疗需求和6个月mortals. MEASUMENTS和主要结果的患病率：中位年龄为78岁（四分位数范围，71-84岁），和54%的机械通气的中位数为7天（四分位数范围，3-16天）。6例受试者（2.6%）在住院期间接受了姑息治疗咨询。然而，88%的患者至少有一种潜在的姑息治疗需求; 22%的患者有慢性伤口，37%的患者在补充氧气后出院，17%的患者接受牧师服务，23%的患者不愿接受复苏，8%的患者被指定为“舒适护理”。结论：来自单一中心的需要急性期后设施护理的老年ICU幸存者有很高的姑息治疗需求负担和很高的6个月死亡率。在医院的重症后急性护理期应针对姑息治疗的评估和干预。
RATIONALE: Adults with chronic critical illness (tracheostomy after ≥ 10 d of mechanical ventilation) have a high burden of palliative needs, but little is known about the actual use and potential need of palliative care services for the larger population of older intensive care unit (ICU) survivors discharged to post-acute care facilities.OBJECTIVES: To determine whether older ICU survivors discharged to post-acute care facilities have potentially unmet palliative care needs.METHODS: We examined electronic records from a 1-year cohort of 228 consecutive adults ≥ 65 years of age who had their first medical-ICU admission in 2009 at a single tertiary-care medical center and survived to discharge to a post-acute care facility (excluding hospice). Use of palliative care services was defined as having received a palliative care consultation. Potential palliative care needs were defined as patient characteristics suggestive of physical or psychological symptom distress or anticipated poor prognosis. We examined the prevalence of potential palliative needs and 6-month mortality.MEASUREMENTS AND MAIN RESULTS: The median age was 78 years (interquartile range, 71-84 yr), and 54% received mechanical ventilation for a median of 7 days (interquartile range, 3-16 d). Six subjects (2.6%) received a palliative care consultation during the hospitalization. However, 88% had at least one potential palliative care need; 22% had chronic wounds, 37% were discharged on supplemental oxygen, 17% received chaplaincy services, 23% preferred to not be resuscitated, and 8% were designated "comfort care." The 6-month mortality was 40%.CONCLUSIONS: Older ICU survivors from a single center who required postacute facility care had a high burden of palliative care needs and a high 6-month mortality. The in-hospital postcritical acute care period should be targeted for palliative care assessment and intervention.