Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy.
Anesthesia and Intensive Care and Pain Relief and Palliative/Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy.
Support Care Cancer. 2018 Jun;26(6):1773-1780. doi: 10.1007/s00520-017-4014-z. Epub 2017 Dec 15.
The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs).
Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions.
Eight hundred and five persons responded to the full list of questions. The highest proportion of respondents was of 36-45 years of age (34%) and catholic (66%). Almost 70% of responders declared that palliative/supportive care are applied in their ICU in case of futility of intensive treatments. Decision on withdrawing/withholding of life-sustaining treatments resulted from team consensus in most cases (58%). In more than 70% of responders' ICUs, there is no collaboration with palliative/supportive care experts. Systematic recording of most frequent symptoms experienced by critically ill patients (e.g., pain, dyspnea, thirst) was not common. Vasopressors, extracorporeal therapies, blood component transfusions and invasive monitoring were the most commonly modified/interrupted measures in case of futility. Almost 85% of respondents have not received training in palliative/supportive care. The proportion of respondents whose institution has a palliative care team and who had training in palliative care was not homogenous across the country.
These data suggest that training in palliative care and its clinical application should be implemented in Italy. Efforts should be made to improve and homogenize the management of dying patients in ICU.
本文旨在收集意大利重症监护病房（ICU）姑息治疗、停止和撤回生命支持治疗以及临终管理的数据。
由意大利麻醉学会支持的意大利麻醉学、镇痛、复苏和重症监护学会（SIAARTI）进行的基于网络的调查。该调查由 27 个封闭式和 2 个开放式问题组成。
805 人对完整的问题清单做出了回应。年龄在 36-45 岁的受访者比例最高（34%），其次是天主教徒（66%）。近 70%的受访者表示，在强化治疗无效的情况下，他们的 ICU 会应用姑息/支持性护理。大多数情况下（58%），停止/撤回生命支持治疗的决定是由团队共识做出的。在超过 70%的受访者的 ICU 中，没有与姑息/支持性护理专家合作。系统记录重症患者最常见的症状（如疼痛、呼吸困难、口渴）并不常见。在治疗无效的情况下，血管加压素、体外治疗、血液成分输注和有创监测是最常修改/中断的措施。近 85%的受访者没有接受过姑息/支持性护理方面的培训。有姑息护理团队和接受过姑息护理培训的受访者比例在全国范围内并不一致。
这些数据表明，在意大利应该实施姑息治疗培训及其临床应用。应努力改善和统一 ICU 临终患者的管理。
