限制对临终重症患者的重症监护治疗：来自阿拉伯联合酋长国一家三级医疗中心的经验。
Limiting intensive care therapy in dying critically Ill patients: Experience from a tertiary care center in United Arab Emirates.
作者信息
Masood Ur Rahman, Said Abuhasna, Faris Chedid, Al Mussady Mousab, Al Jundi Amer
机构信息
Department of Critical Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
Department of Neonatal Intensive Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
出版信息
Int J Crit Illn Inj Sci. 2013 Jul;3(3):200-5. doi: 10.4103/2229-5151.119201.
BACKGROUND
Limitations of life-support interventions, by either withholding or withdrawing support, are integrated parts of intensive care unit (ICU) activities and are ethically acceptable. The end-of-life legal aspects and practices in United Arab Emirates ICUs are rarely mentioned in the medical literature. The objective of this study was to examine the current practice of limiting futile life-sustaining therapies in our ICU, modalities for implementing of these decisions, and documentations in dying critically ill patients.
MATERIALS AND METHODS
This was a retrospective observational study conducted at our ICU. We studied all ICU patients who died from September 2008 to February 2009. Patients' baseline demo-graphics, past medical problems, diagnosis on admission to ICU, and decision to withhold, withdraw and their modalities were collected.
METHODS
This was a retrospective observational study conducted at our ICU. We studied all ICU patients who died from September 2008 to February 2009. Patients' baseline demo-graphics, past medical problems, diagnosis on admission to ICU, and decision to withhold, withdraw and their modalities were collected.
RESULTS
The electronic medical records of 67 patients were reviewed. The commonest method of limiting therapy was no escalation 53.6%. Interventions were withheld in 41.5%. "Do not resuscitate" order was documented in only 16.3%. The commonest method of documenting limitation of therapy was discussion with the family and documenting the prognosis and futility of additional therapy (73.3%). Patients who died early (<48 hrs) compared to patients who died late (>48 hrs) of ICU admission received terminal cardiopulmonary resuscitation more frequently (P < 0.007), had less frequent prognosis documentation (P < 0.009), and had more vasopressors administered (P < 0.006).
CONCLUSION
Withholding therapy after discussion with the family was the preferred mode of limiting therapy in a dying patient.
背景
通过停止或撤销支持来限制生命支持干预措施，是重症监护病房（ICU）工作的组成部分，并且在伦理上是可接受的。阿拉伯联合酋长国ICU中的临终法律方面和实践在医学文献中很少被提及。本研究的目的是调查我们ICU中限制无效生命维持治疗的当前实践、实施这些决定的方式以及对临终重症患者的记录。
材料与方法
这是一项在我们ICU进行的回顾性观察研究。我们研究了2008年9月至2009年2月期间在ICU死亡的所有患者。收集了患者的基线人口统计学资料、既往病史、入住ICU时的诊断以及停止、撤销治疗的决定及其方式。
方法
这是一项在我们ICU进行的回顾性观察研究。我们研究了2008年9月至2009年2月期间在ICU死亡的所有患者。收集了患者的基线人口统计学资料、既往病史、入住ICU时的诊断以及停止、撤销治疗的决定及其方式。
结果
回顾了67例患者的电子病历。限制治疗最常见的方法是不升级治疗（53.6%）。41.5%的患者停止了干预措施。仅16.3%的患者记录了“不要复苏”医嘱。记录治疗限制最常见的方法是与家属讨论并记录预后及额外治疗的无效性（73.3%）。与入住ICU较晚（>48小时）死亡的患者相比，入住ICU较早（<48小时）死亡的患者接受终末期心肺复苏的频率更高（P<0.007），预后记录频率更低（P<0.009），使用血管升压药的频率更高（P<0.006）。
结论
与家属讨论后停止治疗是临终患者限制治疗的首选方式。
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