Department of Anesthesiology and Intensive Care, Friedrich Schiller University Hospital, Jena, Germany.
Crit Care Med. 2010 Apr;38(4):1060-8. doi: 10.1097/CCM.0b013e3181cd1110.
To investigate the epidemiology of and possible factors associated with end-of-life decisions in a surgical intensive care unit.
Analysis of prospectively collected data.
University hospital surgical intensive care unit.
All patients admitted to the surgical intensive care unit between September 2002 and July 2006.
During the study period, 14,720 patients were admitted to the surgical intensive care unit (61.8 male; mean age, 62 yrs). The prevalence of end-of-life decisions was 2.7% (n = 398); 230 patients (1.6%) had a do-not-resuscitate order, 90 (0.6%) had a decision to withhold therapy, and 78 (0.5%) had a decision to withdraw life-supportive therapy. Patients with end-of-life decisions had higher severity scores on the day of intensive care unit admission, were mostly unplanned admissions, were older, and were more commonly referred from the emergency room or other hospitals compared to those who did not have an end-of-life decision. The prevalence of end-of-life decisions increased significantly with the severity of sepsis. An end-of-life decision was made for 29% of the patients who died in the intensive care unit. Intensive care unit and hospital mortality rates were 6.1% and 10.3%, respectively, overall, and 65.1% and 82.2%, respectively, in patients with an end-of-life decision. In multivariate analysis, older age, admission from another hospital, cirrhosis, sepsis syndromes, simplified acute physiology score II, and sequential organ failure assessment scores were independently associated with end-of-life decisions.
Twenty-nine percent of patients who die in the surgical intensive care unit have an end-of-life decision. Severe sepsis/septic shock was associated with a 16-fold increased likelihood of having an end-of-life decision.
调查外科重症监护病房临终决策的流行病学及可能相关因素。
前瞻性收集数据的分析。
大学医院外科重症监护病房。
2002 年 9 月至 2006 年 7 月间入住外科重症监护病房的所有患者。
研究期间，共有 14720 例患者入住外科重症监护病房（61.8%为男性；平均年龄 62 岁）。临终决策的发生率为 2.7%（n=398）；230 例患者（1.6%）有不复苏医嘱，90 例（0.6%）有停止治疗的决定，78 例（0.5%）有终止生命支持治疗的决定。与未做出临终决策的患者相比，做出临终决策的患者在入住重症监护病房当天的严重程度评分更高，多为非计划入院，年龄更大，且多由急诊室或其他医院转入。随着脓毒症严重程度的增加，做出临终决策的比例显著增加。在重症监护病房死亡的患者中有 29%做出了临终决策。重症监护病房和医院的死亡率分别为 6.1%和 10.3%，而做出临终决策的患者分别为 65.1%和 82.2%。多变量分析显示，年龄较大、来自其他医院、肝硬化、脓毒症综合征、简化急性生理学评分Ⅱ和序贯器官衰竭评估评分与临终决策独立相关。
29%在外科重症监护病房死亡的患者做出了临终决策。严重脓毒症/感染性休克患者做出临终决策的可能性增加 16 倍。
