Koff Geoffrey, Vaid Urvashi, Len Edward, Crawford Albert, Oxman David A
1Division of Pulmonary & Critical Care Medicine, Department of Medicine, Crozer-Chester Medical Center, Chester, PA.2Division of Pulmonary and Critical Care Medicine, Department of Medicine, Sidney Kimmel Medical College, Thomas Jefferson University Hospital, Philadelphia, PA.3Division of Pulmonary & Critical Care Medicine, Department of Medicine, Rutgers/Robert Wood Johnson Medical Center, New Brunswick, NJ.4Division of Pulmonary & Critical Care Medicine, Department of Medicine, College of Population Health, Thomas Jefferson University, Philadelphia, PA.
Crit Care Med. 2017 Apr;45(4):e379-e383. doi: 10.1097/CCM.0000000000002260.
To explore differences in the utilization of life support and end-of-life care between patients dying in the medical ICU with cancer compared with those without cancer.
Retrospective review of 403 deaths or hospice transfers in the medical ICU from January 1, 2012, to June 30, 2013.
Urban tertiary care university hospital.
Consecutive medical ICU deaths or hospice transfers over an 18-month period.
None.
One hundred eighty-two patients (45%) had a diagnosis of active cancer and 221 (55%) did not. Despite similar severity of illness, there were significant differences in the use of life support and end-of-life care. Patients without cancer had longer medical ICU length of stay (median, 5 vs 4 d; p = 0.0495), used mechanical ventilation more often and for longer (83.7% vs 70.9%, p = 0.002; 4 vs 3 d, p = 0.017), and initiated dialysis more frequently (26.7% vs 14.8%; p = 0.0038). Patients without active cancer had family meetings later (median, 3 vs 2 d; p = 0.001), less frequent palliative care consultation (17.6% vs 32.4%; p = 0.0006), and took longer to transition to do not resuscitate or comfort care (median, 4 vs 3 d; p = 0.048).
Among patients dying in the medical ICU, the diagnosis of active cancer influences the intensity of life support utilization and the quality of end-of-life care. Patients with active cancer use less life support and may receive better end-of-life care than similar patients without cancer. These differences are likely due to biases or misunderstandings about the trajectory of advanced nonmalignant disease among patients, families, and perhaps providers.
探讨在医疗重症监护病房（ICU）死亡的癌症患者与非癌症患者在生命支持和临终关怀利用方面的差异。
对2012年1月1日至2013年6月30日期间医疗ICU的403例死亡或临终关怀转诊病例进行回顾性研究。
城市三级护理大学医院。
连续18个月期间医疗ICU的死亡病例或临终关怀转诊病例。
无。
182例患者（45%）被诊断为患有活动性癌症，221例患者（55%）未患癌症。尽管疾病严重程度相似，但在生命支持和临终关怀的使用方面存在显著差异。非癌症患者在医疗ICU的住院时间更长（中位数，5天对4天；p = 0.0495），更频繁且更长时间地使用机械通气（83.7%对70.9%，p = 0.002；4天对3天，p = 0.017），更频繁地开始透析（26.7%对14.8%；p = 0.0038）。无活动性癌症的患者家庭会议召开时间较晚（中位数，3天对2天；p = 0.001），姑息治疗咨询频率较低（17.6%对32.4%；p = 0.0006），且转为不进行心肺复苏或舒适护理的时间更长（中位数，4天对3天；p = 0.048）。
在医疗ICU死亡的患者中，活动性癌症的诊断会影响生命支持利用的强度和临终关怀的质量。患有活动性癌症的患者使用的生命支持较少，可能比类似的非癌症患者接受更好的临终关怀。这些差异可能是由于患者、家属以及可能的医护人员对晚期非恶性疾病病程存在偏见或误解所致。
Zotero 插件