Jones Daryl A, McIntyre Tammy, Baldwin Ian, Mercer Inga, Kattula Andrea, Bellomo Rinaldo
Australian and New Zealand Intensive Care Research Centre, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
Crit Care Resusc. 2007 Jun;9(2):151-6.
To assess the characteristics of patients who died in a teaching hospital and the role of the medical emergency team (MET) in their end-of-life care.
This was a retrospective analysis of 105 deaths over the month of May 2005 by a blinded investigator, who documented patient age, parent hospital unit, comorbidities, presence and timing of not-for-resuscitation (NFR) designation, and presence and timing of first MET review. We analysed differences between medical versus surgical patients, NFR versus non-NFR patients, and MET-reviewed versus non-MET-reviewed patients.
Of the 105 patients who died, 80 were medical patients and 25 were surgical patients. Five patients were not designated NFR at the time of death, and three of these had antecedent MET criteria in the 24 hours before death. Of the 100 patients who were designated NFR at the time of death, 35 received a MET call during their admission. Of the 35 MET calls, 10 occurred on the same day as the patient's death, and 12 on the same day as the NFR designation. Documentation of NFR status occurred later in the admission for patients who received a MET call than for those who did not receive a MET call (mean +/-SD, 13.3 +/-16.1 versus 5.3 +/-10.8 days after admission; P = 0.003). Hypotension, hypoxia and tachypnoea were the most common MET triggers, and pulmonary oedema, pneumonia and acute coronary syndromes were the most common reasons for the deterioration in the patient's condition. Following the MET review, patients were admitted to the ICU and newly classified as NFR in 15 and nine of the 35 MET calls, respectively.
Most patients who died in our hospital were designated NFR at the time of death. A third of these patients were seen by the MET before death. In about 10% of cases, the MET participated in the decision to designate the patient NFR.
评估在一家教学医院死亡患者的特征以及医疗急救团队（MET）在其临终关怀中的作用。
这是一位盲法研究者对2005年5月的105例死亡病例进行的回顾性分析，记录了患者年龄、原所属医院科室、合并症、不进行心肺复苏（NFR）指定的存在情况及时间，以及首次MET评估的存在情况及时间。我们分析了内科与外科患者、NFR与非NFR患者以及接受MET评估与未接受MET评估患者之间的差异。
在105例死亡患者中，80例为内科患者，25例为外科患者。5例患者在死亡时未被指定为NFR，其中3例在死亡前24小时有先前的MET标准。在死亡时被指定为NFR的100例患者中，35例在住院期间接到了MET呼叫。在这35次MET呼叫中，10次发生在患者死亡当天，12次发生在NFR指定当天。接受MET呼叫的患者在住院期间记录NFR状态的时间比未接受MET呼叫的患者晚（平均±标准差，入院后13.3±16.1天与5.3±10.8天；P = 0.003）。低血压、缺氧和呼吸急促是最常见的MET触发因素，肺水肿、肺炎和急性冠状动脉综合征是患者病情恶化的最常见原因。在MET评估后，35次MET呼叫中分别有15例和9例患者被收入重症监护病房并新被分类为NFR。
在我们医院死亡的大多数患者在死亡时被指定为NFR。这些患者中有三分之一在死亡前接受了MET会诊。在大约10%的病例中，MET参与了将患者指定为NFR的决策。
