Ritacca Frank V, Simone Carmine, Wax Randy, Craig Katherine G, Walley Keith R
Resident, Department of Medicine, University of Toronto, Canada.
Crit Care. 2002 Apr;6(2):113-6. doi: 10.1186/cc1467. Epub 2002 Feb 6.
Decision-making in the intensive care unit is often very difficult. Although we are encouraged to make evidence-based decisions, this may be difficult for a number of reasons. To begin with, evidence may not exist to answer the clinical question. Second, when there is evidence it may not be applicable to the patient in question or the clinician may be reluctant to apply it to the patient based on a number of secondary issues such as costs, premorbid condition or possible complications. Finally, emotions are often highly charged when caring for patients that have a significant chance of death, and care-givers as well as families are frequently prepared to take chances on a therapy whose benefit is not entirely clear. Steroid use in septic shock is an example of a therapy that makes some sense but has conflicting support in the literature. In this issue of Critical Care Forum, the two sides of this often heated debate are brought to the forefront in an interesting format.
重症监护病房中的决策往往非常困难。尽管我们被鼓励做出基于证据的决策，但由于多种原因，这可能很难做到。首先，可能不存在回答临床问题的证据。其次，当有证据时，它可能不适用于相关患者，或者临床医生可能基于一些次要问题（如成本、病前状况或可能的并发症）而不愿将其应用于患者。最后，在护理有很大死亡风险的患者时，情绪往往高度紧张，护理人员和家属经常愿意冒险采用一种益处并不完全明确的治疗方法。在感染性休克中使用类固醇就是一种有一定道理但在文献中支持观点相互矛盾的治疗方法的例子。在本期《重症监护论坛》中，这场常常激烈的辩论的双方以一种有趣的形式被呈现在了最前沿。
