Peninsula Health, Continuing Education and Development Unit, Hastings Road, Frankston, VIC 3199, Australia.
Aust Crit Care. 2010 Feb;23(1):13-9. doi: 10.1016/j.aucc.2009.10.002. Epub 2009 Nov 14.
Death in the intensive care unit is often predictable. End of life management is often discussed and initiated when futility of care appears evident. Respect for patients wishes, dignity in death, and family involvement in the decision-making process is optimal. This goal may often be elusive.
Our purpose was to review the end of life processes and family involvement within our Unit.
We conducted a chart audit of all deaths in our 10 bed Unit over a 12-month period, reviewing patient demographics, diagnosis on admission, patient acuity, expectation of death and not-for-resuscitation status. Discussions with the family, treatments withheld and withdrawn and extubation practices were documented. The presence of family or next-of-kin at the time of death, the time to death after withdrawal of therapy and family concerns were recorded.
There were 70 patients with a mean age of 69 years. Death was expected in 60 patients (86%) and not-for-resuscitation was documented in 58 cases (85%). Family discussions were held in 63 cases (90%) and treatment was withdrawn in 34 deaths (49%). After withdrawal of therapies, 31 patients (44%) died within 6h. Ventilatory support was withdrawn in 24 cases (36%). Family members were present at the time of death in 46 cases (66%). Family concerns were documented about the end of life care in only 1 case (1.4%).
Our data suggests that death in our Unit was often predictable and that end of life management was a consultative process.
重症监护病房的死亡通常是可以预测的。当治疗无效的情况明显时，通常会讨论并启动生命末期管理。尊重患者的意愿、死亡时的尊严以及让家属参与决策过程是最佳做法。但这一目标往往难以实现。
我们旨在回顾本单位的生命末期处理过程和家属参与情况。
我们对 12 个月内在我们 10 床单位死亡的所有患者进行了病历审核，回顾了患者的人口统计学特征、入院诊断、患者的疾病严重程度、死亡预期和不复苏状态。记录了与家属的讨论、停止和撤回的治疗以及拔管的做法。记录了家属或近亲在死亡时的在场情况、停止治疗后到死亡的时间以及家属的关切。
共有 70 名患者，平均年龄为 69 岁。预计 60 名患者（86%）死亡，58 例（85%）记录了不复苏状态。进行了 63 例（90%）家属讨论，34 例（49%）停止了治疗。停止治疗后，31 例（44%）患者在 6 小时内死亡。24 例（36%）停止了呼吸机支持。46 例（66%）家属在死亡时在场。仅 1 例（1.4%）记录了家属对生命末期护理的关切。
我们的数据表明，本单位的死亡通常是可以预测的，生命末期管理是一个协商过程。
