Weiss Manfred, Michalsen Andrej, Toenjes Anke, Porzsolt Franz, Bein Thomas, Theisen Marc, Brinkmann Alexander, Groesdonk Heinrich, Putensen Christian, Bach Friedhelm, Henzler Dietrich
Clinic of Anaesthesiology, University Hospital Medical School, Alber-Einstein-Allee 23, 89081, Ulm, Germany.
Department of Anesthesiology and Critical Care Medicine, Tettnang Hospital, Tettnang, Germany.
BMC Anesthesiol. 2017 Jul 11;17(1):93. doi: 10.1186/s12871-017-0384-5.
Structural aspects and current practice about end-of-life (EOL) decisions in German intensive care units (ICUs) managed by anesthesiologists are unknown. A survey among intensive care anesthesiologists has been conducted to explore current practice, barriers and opinions on EOL decisions in ICU.
In November 2015, all members of the German Society of Anesthesiology and Intensive Care Medicine (DGAI) and the Association of German Anesthesiologists (BDA) were asked to participate in an online survey to rate the presence or absence and the importance of 50 items. Answers were grouped into three categories considering implementation and relevance: Category 1 reflects high implementation and high relevance, Category 2 low and low, and Category 3 low and high.
Five-hundred and forty-one anesthesiologists responded. Only four items reached ≥90% agreement as being performed "yes, always" or "mostly", and 29 items were rated "very" or "more important". A profound discrepancy between current practice and attributed importance was revealed. Twenty-eight items attributed to Category 1, six to Category 2 and sixteen to Category 3. Items characterizing the most urgent need for improvement (Category 3) referred to patient outcome data, preparation of health care directives and interdisciplinary discussion, standard operating procedures, implementation of practical instructions and inclusion of nursing staff and families in the process.
The present survey affirms an urgent need for improvement in EOL practice in German ICUs focusing on advanced care planning, distinct aspects of changing goals of care, implementation of standard operating procedures, continuing education and reporting of outcome data.
由麻醉医生管理的德国重症监护病房（ICU）中，关于临终（EOL）决策的结构方面和当前实践尚不清楚。已对重症监护麻醉医生进行了一项调查，以探讨ICU中EOL决策的当前实践、障碍和观点。
2015年11月，德国麻醉学与重症医学学会（DGAI）和德国麻醉医生协会（BDA）的所有成员被要求参与一项在线调查，对50项内容的存在与否及重要性进行评分。考虑到实施情况和相关性，答案分为三类：第1类反映高实施率和高相关性，第2类反映低实施率和低相关性，第3类反映低实施率和高相关性。
541名麻醉医生做出了回应。只有4项内容达成≥90%的共识，即“是，总是”或“大多是”会执行，29项内容被评为“非常”或“更重要”。结果显示当前实践与所认为的重要性之间存在显著差异。28项内容属于第1类，6项属于第2类，16项属于第3类。最急需改进的项目（第3类）涉及患者结局数据、医疗保健指令的制定和跨学科讨论、标准操作程序、实用指南的实施以及护理人员和家属参与该过程。
本次调查证实，德国ICU的EOL实践迫切需要改进，重点是高级护理计划、护理目标改变的不同方面、标准操作程序的实施、继续教育以及结局数据的报告。
