Manara Alex R, Thomas Ian, Harding Richard
North Bristol NHS Trust, Bristol, UK.
Wye Valley NHS Trust, Hereford, UK.
J Intensive Care Soc. 2016 Nov;17(4):295-301. doi: 10.1177/1751143716647980. Epub 2016 May 5.
Early prognostication in patients with a devastating brain injury is not always accurate and can lead to inappropriate decisions. We present case histories to support the recent recommendations of the Neurocritical Care Society that treatment withdrawal decisions should be delayed by up to 72 h in these patients. Development of pathways incorporating these recommendations can improve prognostication, enhance end of life care given to these patients and their families, and increase the opportunities to explore the donation wishes of more patients. They may also standardise the approach to decision making in the same way as the recommendations for management of patients after out of hospital cardiac arrest have done.
对严重脑损伤患者进行早期预后判断并不总是准确的,而且可能导致不恰当的决策。我们展示病例史以支持神经重症监护学会最近的建议,即在这些患者中,撤掉治疗的决定应推迟至多72小时。纳入这些建议的流程制定可以改善预后判断,加强给予这些患者及其家属的临终关怀,并增加探究更多患者捐赠意愿的机会。它们还可能像院外心脏骤停后患者管理建议那样,使决策方法标准化。