1Department of Anesthesiology and Critical Care Medicine, Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM. 2Mount Isa Centre for Rural and Remote Health, Faculty of Medicine, Health and Molecular Sciences, James Cook University, Townsville, QLD, Australia. 3New Mexico Donor Services and University of New Mexico School of Medicine, Albuquerque, NM. 4Department of Emergency Medicine, University of New Mexico School of Medicine, Albuquerque, NM. 5Department of Surgery, University of New Mexico School of Medicine, Albuquerque, NM. 6Department of Neurosurgery, Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM. 7Department of Anesthesiology and Critical Care Medicine, University of New Mexico School of Medicine, Albuquerque, NM.
Crit Care Med. 2014 Apr;42(4):934-42. doi: 10.1097/CCM.0000000000000102.
To evaluate if a family presence educational intervention during brain death evaluation improves understanding of brain death without affecting psychological distress.
Randomized controlled trial.
Four ICUs at an academic tertiary care center.
Immediate family members of patients suspected to have suffered brain death.
Subjects were group randomized to presence or absence at bedside throughout the brain death evaluation with a trained chaperone. All randomized subjects were administered a validated "understanding brain death" survey before and after the intervention. Subjects were assessed for psychological well-being between 30 and 90 days after the intervention.
Follow-up assessment of psychological well-being was performed using the Impact of Event Scale and General Health Questionnaire. Brain death understanding, Impact of Event Scale, and General Health Questionnaire scores were analyzed using Wilcoxon nonparametric tests. Analyses were adjusted for within family correlation. Fifty-eight family members of 17 patients undergoing brain death evaluation were enrolled: 38 family members were present for 11 brain death evaluations and 20 family members were absent for six brain death evaluations. Baseline understanding scores were similar between groups (median 3.0 [presence group] vs 2.5 [control], p = 0.482). Scores increased by a median of 2 (interquartile range, 1-2) if present versus 0 (interquartile range, 0-0) if absent (p < 0.001). Sixty-six percent of those in the intervention group achieved perfect postintervention "understanding" scores, compared with 20% of subjects who were not present (p = 0.02). Median Impact of Event Scale and General Health Questionnaire scores were similar between groups at follow-up (Impact of Event Scale: present = 20.5, absent = 23.5, p = 0.211; General Health Questionnaire: present = 13.5, absent = 13.0, p = 0.250).
Family presence during brain death evaluation improves understanding of brain death with no apparent adverse impact on psychological well-being. Family presence during brain death evaluation is feasible and safe.
评估在脑死亡评估期间进行家庭存在教育干预是否会提高对脑死亡的理解而不会影响心理困扰。
随机对照试验。
学术三级保健中心的四个 ICU。
疑似脑死亡患者的直系亲属。
将受试者随机分为有或无经过培训的监护人在床边全程参与脑死亡评估。所有随机分组的受试者在干预前后均接受了一项经过验证的“理解脑死亡”调查。在干预后 30 至 90 天对受试者进行心理幸福感评估。
使用事件影响量表和一般健康问卷对心理幸福感的随访评估。使用 Wilcoxon 非参数检验分析脑死亡理解、事件影响量表和一般健康问卷评分。分析调整了家庭内相关性。17 例脑死亡评估患者的 58 位家属参与：11 例脑死亡评估中有 38 位家属在场，6 例脑死亡评估中有 20 位家属不在场。两组的基线理解评分相似（中位数 3.0[存在组]比 2.5[对照组]，p = 0.482）。如果存在，则评分中位数增加 2（四分位距，1-2），如果不存在，则评分中位数增加 0（四分位距，0-0）（p <0.001）。干预组中有 66%的人达到了完美的干预后“理解”评分，而对照组中只有 20%的人未达到（p = 0.02）。在随访时，两组的事件影响量表和一般健康问卷评分中位数相似（事件影响量表：存在=20.5，不存在=23.5，p=0.211；一般健康问卷：存在=13.5，不存在=13.0，p=0.250）。
在脑死亡评估期间，家属的存在提高了对脑死亡的理解，且对心理健康没有明显的不良影响。在脑死亡评估期间，家属的存在是可行且安全的。
