Schmidt Matthieu, Demoule Alexandre, Deslandes-Boutmy Emmanuelle, Chaize Marine, de Miranda Sandra, Bèle Nicolas, Roche Nicolas, Azoulay Elie, Similowski Thomas
Crit Care. 2014 Jun 4;18(3):R115. doi: 10.1186/cc13906.
ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission.
COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation.
Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation.
The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.
超过25%的慢性阻塞性肺疾病（COPD）患者在疾病过程中的某个时间需要入住重症监护病房（ICU）。然而，关于医生如何与COPD患者沟通ICU入住事宜的信息有限。
对来自19个法国ICU的COPD患者及其亲属在ICU出院时进行访谈，了解他们对COPD的认识。法国肺科医生自行报告他们告知COPD患者并讨论重症监护治疗偏好的做法。最后，肺科医生和ICU医生报告了将COPD患者转入ICU并建议进行有创机械通气的障碍和促进因素。
126名COPD患者和102名亲属填写了自我报告问卷，173名肺科医生和135名ICU医生接受了访谈。对于41%（n = 39）的患者和54%（n = 51）的亲属，入院前从未预期过会入住ICU。一半的患者在COPD病程中未被肺科医生常规告知可能在某个时间入住ICU。此外，在肺科医生的定期就诊期间，未向COPD患者解释治疗选择（即无创通气、插管和机械通气或气管切开术）。肺科医生和ICU医生对与ICU入住和插管相关的决策过程有不同的看法。
肺科医生向患者及其家属提供的关于COPD预后、入住ICU的风险和特定护理的信息可以得到改善，以便根据患者的个人价值观和偏好提供ICU护理。鉴于肺科医生和重症监护医生在决策过程中存在差异，可能应该讨论一种更具协作性的方法。
