儿科重症监护医生在床边护士眼中撤机/限制生命支持的门槛存在差异：一项多中心调查研究。

Variability in the pediatric intensivists' threshold for withdrawal/limitation of life support as perceived by bedside nurses: a multicenter survey study.

机构信息

University of Alberta, Stollery Children's Hospital, 8440 112 Street, Edmonton, Alberta, T6G 2B7, Canada.

出版信息

Ann Intensive Care. 2011 Aug 8;1(1):31. doi: 10.1186/2110-5820-1-31.

DOI:10.1186/2110-5820-1-31

PMID:21906385

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3224498/

Abstract

BACKGROUND

We hypothesized that bedside nurses perceive significant variability in the pediatric intensivist thresholds for approaching a family about withdrawal/limitation of life-sustaining therapy.

METHODS

All nurses working in four university-affiliated medical-surgical pediatric intensive care units staffed by 11, 7, 6, and 5 intensivists with 36, 18, 10, and 8 beds were sent three mailings of a survey asking questions about intensivist decisions for withdrawal/limitation of life-sustaining therapy. Responses were tabulated; chi-square compared results among centers; a p < 0.05 after Bonferroni correction was significant.

RESULTS

The response rate was 205 of 415 (49%); 152 of 205 (74%) disagreed with the statement that each of the intensivists had the same threshold for approaching a family to suggest withdrawal/limitation of life-sustaining therapy, with no significant difference between centers. Also, 110 of 205 (54%) and 119 of 205 (58%) disagreed with the statement that each intensivist has the same threshold of the patient's chance for survival or projected quality of life when making a decision to withdraw/limit life-sustaining therapy with no significant difference between centers. The threshold to suggest withdraw/limit life-sustaining therapy based on chance of survival or projected quality of life differs between intensivists by at least 10% according to 113 of 184 (61%) and 121 of 184 (66%) nurses; the two larger centers had significantly higher difference among intensivists for projected quality of life. Fifty-five of 200 (27%) disagreed with the statement that they would have equal confidence in each intensivist accepting a recommendation for withdrawal/limitation of life-sustaining therapy for their own child, with no difference between centers.

CONCLUSIONS

Bedside pediatric intensive care unit nurses in this multicenter Canadian study perceive wide variability in intensivist thresholds for approaching a family to suggest withdrawal/limitation of life-sustaining therapy.

摘要

背景

我们假设床边护士对儿科重症监护医师接近家属提出停止/限制生命支持治疗的门槛存在显著差异。

方法

向四家大学附属的医疗外科儿科重症监护病房的所有护士发送了三封调查邮件，询问他们关于停止/限制生命支持治疗的重症监护医师决策。对回复进行了制表；通过卡方检验比较了中心之间的结果；Bonferroni 校正后 p 值 < 0.05 有统计学意义。

结果

回复率为 415 名护士中的 205 名（49%）；205 名护士中有 152 名（74%）不同意每个重症监护医师对接近家属提出停止/限制生命支持治疗的门槛都相同的说法，各中心之间没有显著差异。此外，205 名护士中有 110 名（54%）和 205 名护士中有 119 名（58%）不同意每个重症监护医师在做出停止/限制生命支持治疗的决策时，对患者的生存机会或预期生活质量都有相同的门槛的说法，各中心之间没有显著差异。根据 184 名护士中的 113 名（61%）和 184 名护士中的 121 名（66%），至少有 10%的重症监护医师在建议停止/限制生命支持治疗的生存机会或预期生活质量方面存在差异；两个较大的中心在重症监护医师对预期生活质量的差异方面存在显著差异。200 名护士中有 55 名（27%）不同意他们对每个重症监护医师接受停止/限制生命支持治疗的建议的信心相等的说法，各中心之间没有差异。