UCI, Hospital de Sagunto, Sagunto, Valencia, España.
UCI, Hospital de Sagunto, Sagunto, Valencia, España.
Med Intensiva. 2017 Dec;41(9):523-531. doi: 10.1016/j.medin.2017.01.007. Epub 2017 Apr 25.
Multiple interventions are performed in critical patients admitted to Intensive Care Units (ICUs). This study explores the presence in the daily practice of ICUs of elements related to the 6 bioethics quality indicators of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units, and the participation of their members in the hospital ethics committees.
A multicenter observational study was carried out, using a survey exploring descriptive aspects of the ICUs, with 25 questions related to bioethics quality indicators, and assessing the participation of ICU members in the hospital ethics committees. The ICUs were classified by size (larger or smaller than 10 beds) and type of hospital (public/private-public concerted center, with/without teaching).
The 68 analyzed surveys revealed: daily informing of the family (97%), carried out in the information room (82%); end-of-life care protocols (44%); life support limitation form (48.43%); and physical containment protocol (40%). Compliance with the informed consent process referred to different procedures is: tracheostomy (92%), vascular procedures (76%), and extrarenal clearance (25%). The presence of ICU members in the hospital ethics committee is currently frequent (69%).
Information supplied to relatives is adequate, although there are ICUs without an information room. Compliance with the informed consent requirements of various procedures is insufficient. The participation of ICU members in the hospital ethics committees is frequent. The results obtained suggest a chance for improvement in the bioethical quality of the ICU.
入住重症监护病房(ICU)的危重症患者通常会接受多种干预措施。本研究旨在探讨 ICU 日常实践中是否存在与西班牙重症监护和冠心病学会的 6 项生物伦理学质量指标相关的要素,以及其成员参与医院伦理委员会的情况。
采用多中心观察性研究方法,通过问卷调查对 ICU 的描述性方面进行了探索,共 25 个问题涉及生物伦理学质量指标,并评估了 ICU 成员参与医院伦理委员会的情况。根据床位数(大于或小于 10 张床)和医院类型(公立/公立-私立合作中心,有/无教学)对 ICU 进行了分类。
对 68 份经过分析的调查问卷进行分析后发现:97%的 ICU 每天都会向家属通报情况,通报地点通常是信息室(82%);44%的 ICU 制定了临终关怀方案;48.43%的 ICU 制定了生命支持限制表格;40%的 ICU 制定了身体约束方案。在各种程序中,告知同意过程的合规性涉及不同的程序:气管切开术(92%)、血管程序(76%)和肾脏外清除术(25%)。目前 ICU 成员在医院伦理委员会中经常出现(69%)。
向家属提供的信息是充分的,尽管有些 ICU 没有信息室。各种程序的知情同意要求的合规性不足。ICU 成员参与医院伦理委员会的情况较为普遍。研究结果表明,ICU 的生物伦理学质量仍有改进的空间。