重症监护病房死亡原因及特征：一项前瞻性多中心研究。

Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study.

机构信息

From the Réanimation Polyvalente et Surveillance Continue, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France (J.-C.O., Y.W., C.I.); Service d'Anesthésie et des Réanimations Chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France (N.M., G.D.); Département d'Anesthésie-Réanimation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France (B.A.); Réanimation Médicale, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France (L.A.); Réanimation Chirurgicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (F.A.); Réanimation, Centre Hospitalier Interrégional de Compiègne Noyon, Compiègne, France (G.B.); Réanimation Adultes et Unité de Soins Intensifs, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France (J.-M.C.); Réanimation Polyvalente, Hôpital Sainte-Musse, Centre Hospitalier Interrégional de Toulon-La Seyne sur mer, Toulon, France (J.D.-G., C.G.); Réanimations, Centre Hospitalier Universitaire de Amiens Picardie-Site Sud, Amiens, France (H.D.); Anesthésie et Réanimation Adulte, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France (M.G.); Service de Réanimation, Hôpital Inter-Armées Sainte-Anne, Toulon, France (P.G.); Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (B.G.); Réanimation Médicale, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France (H.H.); Département d'Anesthésie et de Réanimation B, Centre Hospitalier Universitaire de Montpellier, Montpellier, France (S.J.); Division Anesthésie Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, Nîmes, France (J.-Y.L.); Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Rennes, France (Y.M.); Réanimation Polyvalente B, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest En Jarez, France (J.M.); Service d'Anesthésie-Réanimation II, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France (A.O.); Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Dupuytren, Limoges, France (N.P.); Réanimation Polyvalente, Centre Hospitalier de Beauvais, Beauvais, France (A.-M.G.R.); Réanimation et Surveillance Continue, Centre Hospitalier de Annecy Genevois, Epagny Metz-Tessy, France (M.S.); Service de Réanimation Polyvalente, Centre Hospitalier Princesse Grace, Monaco City, Monaco (A.T.); and Service d'Anesthésie Réanimation, Hôpital de la Conception (S.W.) and Service Anesthésie et Réanimation, Hôpital Nord (L.Z., M.L.), Assistance Publique-Hôpitaux de Marseille, Marseille, France.

出版信息

Anesthesiology. 2017 May;126(5):882-889. doi: 10.1097/ALN.0000000000001612.

DOI:10.1097/ALN.0000000000001612

PMID:28296682

Abstract

BACKGROUND

Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.

METHODS

An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest).

RESULTS

A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths.

CONCLUSIONS

In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.

摘要

背景

在选定的人群中描述了不同的死亡模式，但很少有数据报告重症监护病房人群死亡的特征。本研究分析了危重症患者死亡的原因和特征，并比较了预期死亡患者和意外死亡患者。

方法

在 96 个重症监护病房进行了一项观察性多中心队列研究。在 1 年内，每个重症监护病房被随机分配在 1 个月内参加。收集所有在重症监护病房死亡的患者的人口统计学数据、器官衰竭特征（序贯器官衰竭评估亚评分大于或等于 3）和器官支持情况。死亡方式定义为预期（在停止或撤销治疗或脑死亡后）或意外（尽管采用了全面治疗或突然难治性心脏骤停）。

结果

在研究期间共纳入 698 例患者。在死亡时，84%的患者有一个或多个器官衰竭（主要是血流动力学），89%的患者需要至少一种器官支持（主要是机械通气）。225 例和 473 例分别被认为是意外和预期死亡。与预期死亡相比，意外死亡发生得更早（1 天与 5 天；P<0.001），器官衰竭更少（1[1 到 2]与 1[1 到 3]；P<0.01），器官支持更多（2[2 到 3]与 1[1 到 2]；P<0.01）。停止或撤销治疗占死亡人数的一半。