法语国家儿科重症监护病房中关于维持生命治疗的质疑和放弃治疗的时间利用情况的流行率。
Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in francophone PICUs.
机构信息
Réanimation Pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, 59037 Lille Cedex, France.
出版信息
Intensive Care Med. 2011 Oct;37(10):1648-55. doi: 10.1007/s00134-011-2320-3. Epub 2011 Aug 16.
PURPOSE
Our goal is to assess the prevalence of questioning about the appropriateness of initiating or maintaining life-sustaining treatments (LST) in French-speaking paediatric intensive care units (PICUs) and to evaluate time utilisation related to decision-making processes (DMP).
METHODS
18-month, multicentre, prospective, descriptive, observational study in 15 French-speaking PICUs.
RESULTS
Among the 5,602 children admitted, 410 died (7.3%), including 175 after forgoing LST (42.7% of deaths). LST was questioned in 308 children (5.5%) with a prevalence of 13.3 per 100 patient-days. More than 30% of children survived despite the appropriateness of LST being questioned (23% despite a decision to forgo treatment). Median caregiver time spent on making and presenting the decisions was 11 h per child.
CONCLUSIONS
In this study, on any given day in each 10-bed PICU, there was more than one child for whom a DMP was underway. Of children, 23% survived despite a decision to forgo LST being made, which underlines the need to elaborate a care plan for these children. Also, DMP represented a large amount of staff time that is undervalued but necessary to ensure optimal palliative practice in PICU.
目的
我们的目标是评估法语儿科重症监护病房（PICU）中询问启动或维持生命支持治疗（LST）的适宜性的流行情况，并评估与决策过程（DMP）相关的时间利用情况。
方法
在 15 个法语 PICU 中进行了为期 18 个月的多中心、前瞻性、描述性、观察性研究。
结果
在 5602 名入院儿童中，有 410 名死亡（7.3%），其中 175 名在放弃 LST 后死亡（占死亡人数的 42.7%）。在 308 名儿童（5.5%）中询问了 LST，患病率为每 100 个患者日 13.3 例。尽管询问了 LST 的适宜性，但仍有超过 30%的儿童存活（尽管决定放弃治疗，但仍有 23%的儿童存活）。每例患儿的照护者在制定和提出决策上花费的中位数时间为 11 小时。
结论
在这项研究中，在每个 10 床 PICU 的任意一天，都有不止一名患儿正在进行 DMP。有 23%的患儿尽管做出了放弃 LST 的决定，但仍存活下来，这突出表明需要为这些患儿制定护理计划。此外，DMP 代表了大量的员工时间，这些时间虽然没有得到充分重视，但对于确保 PICU 中的最佳姑息治疗实践是必要的。
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