Creutzfeldt Claire J, Wunsch Hannah, Curtis J Randall, Hua May
Department of Neurology, Harborview Medical Center, University of Washington, Seattle, WA, USA,
Neurocrit Care. 2015 Aug;23(1):14-21. doi: 10.1007/s12028-015-0143-8.
Palliative care needs among patients in the neurological intensive care unit (neuroICU) are poorly characterized. Our aim was to explore the prevalence and type of potential palliative care consultation triggers in neuroICUs.
We conducted a retrospective cohort study of neuroICU admissions in Project IMPACT from 2001 to 2008. We assessed the prevalence of neuroICU admissions meeting one or more of five validated palliative care consultation triggers and compared the percentage of admissions meeting these triggers in other ICUs from the same hospitals.
Among 1268 admissions to 2 neuroICUs, 200 (15.8 %) met one or more triggers for palliative care consultation. Among 13,694 admissions to non-neuroICUs in the same hospitals, 1909 (13.9 %) met one or more palliative care triggers (p = 0.44). The most common trigger in the neuroICU was intracerebral hemorrhage with mechanical ventilation (n = 92; 7.3 %). The most common trigger in non-neuroICUs was ICU admission following ≥10-day hospital stay (n = 805; 5.9 %). Although ICU mortality was not significantly higher in neuroICU vs. non-neuroICU patients meeting triggers (23.4 vs 19.9 %, p = 0.46), neuroICU patients were significantly more likely to have withdrawal of life-sustaining therapies (19.4 vs 8.0 %, p < 0.001).
Among neuroICU patients, 15.8 % met triggers for palliative care consultation. Although prevalence of admissions meeting any trigger was similar amongst all ICUs, neuroICU admissions met different types of triggers and were more likely to have withdrawal of life-sustaining therapy. These data suggest that palliative care needs are common among neuroICU patients and discussions with patients and families regarding limitation of life-sustaining therapy may differ in this setting.
神经重症监护病房（neuroICU）患者的姑息治疗需求尚未得到充分描述。我们的目的是探讨神经重症监护病房中潜在姑息治疗会诊触发因素的患病率和类型。
我们对2001年至2008年“影响项目”中神经重症监护病房的入院患者进行了一项回顾性队列研究。我们评估了符合五个经过验证的姑息治疗会诊触发因素中一个或多个的神经重症监护病房入院患者的患病率，并比较了同一医院其他重症监护病房中符合这些触发因素的入院患者的百分比。
在2个神经重症监护病房的1268例入院患者中，200例（15.8%）符合一个或多个姑息治疗会诊触发因素。在同一医院的13694例非神经重症监护病房入院患者中，1909例（13.9%）符合一个或多个姑息治疗触发因素（p = 0.44）。神经重症监护病房中最常见的触发因素是脑出血伴机械通气（n = 92；7.3%）。非神经重症监护病房中最常见的触发因素是住院≥10天后入住重症监护病房（n = 805；5.9%）。虽然符合触发因素的神经重症监护病房患者与非神经重症监护病房患者的重症监护病房死亡率没有显著差异（23.4%对19.9%，p = 0.46），但神经重症监护病房患者更有可能接受生命维持治疗的撤除（19.4%对8.0%，p < 0.001）。
在神经重症监护病房患者中，15.8%符合姑息治疗会诊触发因素。虽然所有重症监护病房中符合任何触发因素的入院患病率相似，但神经重症监护病房入院患者符合不同类型的触发因素，并且更有可能接受生命维持治疗的撤除。这些数据表明，姑息治疗需求在神经重症监护病房患者中很常见，并且在这种情况下，与患者及其家属关于生命维持治疗限制的讨论可能会有所不同。
