Palliative Care Service, Massachusetts General Hospital, and Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA.
J Pain Symptom Manage. 2010 Feb;39(2):309-13. doi: 10.1016/j.jpainsymman.2009.11.242.
The safety of patients in U.S. hospitals is a serious problem, with adverse events because of medical error affecting a significant proportion of hospitalized patients. Patients at the end of life are particularly vulnerable and are at risk of potential adverse events. This article presents a case in which opioids were rapidly titrated to neurotoxic doses in a patient who was terminally extubated. The patient was profoundly sedated and was noted to have Cheyne-Stokes breathing. The possibility of opioid-related iatrogenic harm is raised, and a discussion of what counts as medical error in these circumstances is explored. Palliative care specialists have a unique responsibility to provide guidance and establish a standard of care that clinicians should adhere to. Prevention of harm in dying patients should be a priority in the hospital setting.
美国医院的患者安全是一个严重的问题，由于医疗失误导致的不良事件影响了相当一部分住院患者。临终患者尤其脆弱，存在潜在不良事件的风险。本文介绍了一例在终末期拔管的患者中，阿片类药物被快速滴定至神经毒性剂量的病例。该患者深度镇静，并出现潮式呼吸。阿片类药物相关医源性伤害的可能性被提出，并探讨了在这种情况下什么算作医疗错误。姑息治疗专家有责任提供指导，并建立临床医生应遵循的护理标准。在医院环境中，预防临终患者受到伤害应是首要任务。
