Center for Bioethics, University of Pennsylvania School of Medicine, Philadelphia, USA.
Intensive Care Med. 2011 Jul;37(7):1210-7. doi: 10.1007/s00134-011-2257-6. Epub 2011 Jun 7.
To examine intensive care unit (ICU) clinicians' willingness to trade off societal benefits in favor of a small chance of rescuing an identifiable critically ill patient.
We sent mixed-methods questionnaires to national samples of US ICU clinicians, soliciting their preferences for allocating their last bed to a gravely ill patient with little chance to survive, versus a deceased or dying patient for whom aggressive management could help others through organ donation.
Complete responses were obtained from 684 of 2,206 physicians (31.0%) and 438 of 988 nurses (44.3%); there was no evidence of non-response bias. Physicians were more likely than nurses to adhere to the "rule of rescue" by allocating the last bed to the gravely ill patient (45.9 vs. 32.6%, difference = 13.2%; 95% CI 9.1-17.3%). The magnitude of the social benefit to be obtained through organ donor management (5 or 30 life-years added for transplant recipients) had small and inconsistent effects on clinicians' willingness to prioritize the donor. In qualitative analyses, the most common reason for allocating the last bed to an identifiable patient (identified by 65% of physicians and 75% of nurses) was that clinicians perceived strong obligations to identifiable living patients.
More than one-third of ICU clinicians forewent substantial social benefits so as to devote resources to an individual patient unlikely to benefit from them. Such allegiance to the rule of rescue suggests challenges for efforts to reform ICU triage practices.
考察重症监护病房（ICU）临床医生是否愿意权衡社会效益，以换取抢救少数明确病危患者的微小机会。
我们向美国 ICU 临床医生的全国样本发送了混合方法问卷，征求他们对以下两种情况的偏好：将最后一张病床分配给一位几乎没有生存机会的重病患者，还是分配给一位通过积极治疗可以通过器官捐献帮助他人的死亡或濒临死亡的患者。
从 2206 名医生中获得了 684 名（31.0%）和 988 名护士中获得了 438 名（44.3%）的完整回复，没有证据表明存在非回复偏差。医生比护士更倾向于通过将最后一张病床分配给重病患者来遵守“救援规则”（45.9%对 32.6%，差异为 13.2%；95%置信区间为 9.1-17.3%）。通过器官捐献管理获得的社会收益（为移植受者增加 5 或 30 个生命年）的大小对临床医生优先考虑捐献者的意愿有很小且不一致的影响。在定性分析中，将最后一张病床分配给可识别患者（被 65%的医生和 75%的护士识别）的最常见原因是临床医生认为对可识别的存活患者有强烈的义务。
超过三分之一的 ICU 临床医生放弃了大量的社会效益，以便将资源用于不太可能从中受益的个别患者。这种对救援规则的忠诚表明，努力改革 ICU 分诊实践面临挑战。
