快速反应系统和临终关怀。
The rapid response system and end-of-life care.
机构信息
aAustin Hospital, Heidelberg, Victoria, Australia bDepartment of Anesthesiology and Critical Care Medicine, Armstrong Institute for Patient Safety and Quality, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA cCritical Care, University College London Hospitals NHS Foundation Trust dCity University, London, UK.
出版信息
Curr Opin Crit Care. 2013 Dec;19(6):616-23. doi: 10.1097/MCC.0b013e3283636be2.
PURPOSE OF REVIEW
To review the recent observational studies reporting the role of the rapid response team (RRT) in end-of-life care (EOLC) planning for hospitalized patients.
RECENT FINDINGS
Initial RRT studies focussed on its role in detecting and preventing avoidable morbidity. However, patients who are in the process of dying will also trigger RRT activation criteria. Single-centre studies from several countries reveal that up to 25% of RRT calls involve patients with a pre-existing limitation of medical therapy (LOMT) and 10% result in new implementation of a new LOMT. A recent seven hospital study revealed that such EOLC RRT calls occur in significantly older patients, who are less likely to be from home and more likely to be admitted with a nonsurgical condition. Importantly, almost 50% of patients subject to EOLC RRT call die in hospital, and in many cases the last RRT call occurs on the day of death.
SUMMARY
Up to one-third of RRT calls involve patients at the end of their life. Better understanding of the features of these patients may guide improved advance care and EOLC planning for hospitalized patients.
目的综述
回顾近期观察性研究报告，探讨快速反应团队（RRT）在住院患者临终关怀（EOLC）规划中的作用。
最新发现
最初的 RRT 研究集中在其在检测和预防可避免的发病率方面的作用。然而，正在走向死亡的患者也会触发 RRT 激活标准。来自多个国家的单中心研究表明，多达 25%的 RRT 呼叫涉及有预先存在的医疗限制（LOMT）的患者，10%导致新的 LOMT 实施。最近的一项七家医院的研究表明，此类 EOLC RRT 呼叫发生在年龄明显较大的患者中，他们不太可能来自家庭，更有可能因非手术状况入院。重要的是，近 50%的接受 EOLC RRT 呼叫的患者在医院死亡，在许多情况下，最后一次 RRT 呼叫发生在死亡当天。
总结
多达三分之一的 RRT 呼叫涉及生命末期的患者。更好地了解这些患者的特征可能有助于指导对住院患者的改进的预嘱和 EOLC 规划。
Zotero 插件