Graw Jan A, Spies Claudia D, Kork Felix, Wernecke Klaus-D, Braun Jan-Peter
Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany,
World J Surg. 2015 Mar;39(3):644-51. doi: 10.1007/s00268-014-2884-5.
Most deaths on the intensive care unit (ICU) occur after end-of-life decisions (EOLD) have been made. During the decision-making process, responsibility is often shared within the caregiver team and with the patients' surrogates. The intensive care unit length of stay (ICU-LOS) of surgical ICU-patients depends on the primary illness as well as on the past medical history. Whether an increasing ICU-LOS affects the process of EOLD making is unknown.
A retrospective analysis was conducted on all deceased patients (n = 303) in a 22-bed surgical ICU of a German university medical center. Patient characteristics were compared between surgical patients with an ICU-LOS up to 1 week and those with an ICU-LOS of more than 7 days.
Deceased patients with a long ICU-LOS received more often an EOLD (83.2% vs. 63.6%, p = 0.001). Groups did not differ in urgency of admission. Attending intensivists participated in every EOLD. Participation of surgeons was significantly higher in patients with a short ICU-LOS (24.1%, p = 0.003), whereas nurses and the patients' surrogates were involved more frequently in patients with a long ICU-LOS (18.8%, p = 0.021 and 18.9%, p = 0.018, respectively).
EOLDs of surgical ICU-patients are associated with the ICU-LOS. Reversal of the primary illness leads the early ICU course, while in prolonged ICU-LOS, the patients' predicted will and the expected post-ICU-quality of life gain interest. Nurses and the patients' surrogates participate more frequently in EOLDs with prolonged ICU-LOS. To improve EOLD making on surgical ICUs, the ICU-LOS associated participation of the different decision makers needs further prospective analysis.
重症监护病房（ICU）的大多数死亡发生在做出临终决定（EOLD）之后。在决策过程中，责任通常由护理团队和患者代理人共同承担。外科ICU患者的ICU住院时间（ICU-LOS）取决于原发性疾病以及既往病史。ICU-LOS的增加是否会影响EOLD的决策过程尚不清楚。
对德国大学医学中心一个拥有22张床位的外科ICU中的所有死亡患者（n = 303）进行回顾性分析。比较了ICU-LOS长达1周的外科患者和ICU-LOS超过7天的患者的患者特征。
ICU-LOS长的死亡患者更常接受EOLD（83.2%对63.6% , p = 0.001）。两组在入院紧急程度上没有差异。主治重症监护医生参与了每一次EOLD。外科医生在ICU-LOS短 的患者中的参与率显著更高（24.1% , p = 0.003），而护士和患者代理人在ICU-LOS长的患者中参与得更频繁（分别为18.8% , p = 0.021和18.9% , p = 0.018）。
外科ICU患者的EOLD与ICU-LOS相关。原发性疾病的好转主导了ICU早期病程，而在ICU-LOS延长时，患者的预测意愿和ICU后的预期生活质量受到关注。护士和患者代理人在ICU-LOS延长的EOLD中参与得更频繁。为了改善外科ICU的EOLD决策，不同决策者与ICU-LOS相关的参与情况需要进一步的前瞻性分析。
