Botha John, Tiruvoipati Ravindranath, Goldberg David
Department of Intensive Care Medicine, Frankston Hospital, Frankston, Victoria 3199, Australia.
N Z Med J. 2013 Sep 27;126(1383):58-71.
Intensive care provides support for acute reversible organ failure and most patients who receive intensive care recover from their illness. In some patients organ failure may become irreversible and in these patients further treatment or organ support may be considered futile. Emerging technologies and expertise can enable the medical profession to prolong life / death indefinitely without curing or controlling the underlying disease process. Introduction of ultramodern organ supports such as extracorporeal life-support systems, ventricular assist devices and organ transplantation surgeries have introduced some degree of ambiguity in defining futility of care. Furthermore medico legal implications of futility of care introduce further complexities in defining and instituting futile treatments. In this review we discuss the evolution of the concept of futility of care, review the various meanings of the term "futility of care", explore the complexities of management when care is considered futile, offer suggestions as to how such patients and their families could be managed. We also review the legal framework when consensus is not achieved.
重症监护为急性可逆性器官衰竭提供支持，大多数接受重症监护的患者会康复。在一些患者中，器官衰竭可能会变得不可逆，对于这些患者，进一步的治疗或器官支持可能被认为是徒劳的。新兴技术和专业知识使医疗行业能够无限期地延长生命/死亡，而无需治愈或控制潜在的疾病进程。超现代器官支持技术的引入，如体外生命支持系统、心室辅助装置和器官移植手术，在界定护理的徒劳性方面带来了一定程度的模糊性。此外，护理徒劳的医学法律含义在界定和实施徒劳治疗方面引入了进一步的复杂性。在这篇综述中，我们讨论了护理徒劳概念的演变，回顾了“护理徒劳”一词的各种含义，探讨了在认为护理徒劳时管理的复杂性，就如何管理此类患者及其家属提供建议。我们还回顾了在未达成共识时的法律框架。
