Grunauer Michelle, Mikesell Caley
Escuela de Medicina, Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador.
Pediatric Intensive Care Unit, Hospital de los Valles, Quito, Ecuador.
Front Pediatr. 2018 Jan 23;6:3. doi: 10.3389/fped.2018.00003. eCollection 2018.
It is estimated that 6.3 million children who die annually need pediatric palliative care (PPC) and that only about 10% of them receive the attention they need because about 98% of them live in under-resourced settings where PPC is not accessible. The consultative model and the integrated model of care (IMOC) are the most common strategies used to make PPC available to critically ill children. In the consultative model, the pediatric intensive care unit (PICU) team, the patient, or their family must request a palliative care (PC) consultation with the external PC team for a PICU patient to be evaluated for special care needs. While the consultation model has historically been more popular, issues related to specialist availability, referral timing, staff's personal biases, misconceptions about PC, and other factors may impede excellent candidates from receiving the attention they need in a timely manner. Contrastingly, in the IMOC, family-centered care, PC tasks, and/or PC are a standard part of the treatment automatically available to all patients. In the IMOC, the PICU team is trained to complete critical and PC tasks as a part of normal daily operations. This review investigates the claim that the IMOC is the best model to meet extensive PPC needs in PICUs, especially in low-resource settings; based on an extensive review of the literature, we have identified five reasons why this model may be superior. The IMOC appears to: (1) improve the delivery of PPC and pediatric critical care, (2) allow clinicians to better respond to the care needs of patients and the epidemiological realities of their settings in ways that are consistent with evidence-based recommendations, (3) facilitate the universal delivery of care to all patients with special care needs, (4) maximize available resources, and (5) build local capacity; each of these areas should be further researched to develop a model of care that enables clinicians to provide pediatric patients with the highest attainable standard of health care. The IMOC lays out a pathway to provide the world's sickest, most vulnerable children with access to PPC, a human right to which they are entitled by international legal conventions.
据估计，每年有630万死亡儿童需要儿科姑息治疗（PPC），但其中只有约10%的儿童得到了他们所需的关注，因为约98%的儿童生活在资源匮乏的地区，无法获得PPC。咨询模式和综合护理模式（IMOC）是为重症儿童提供PPC的最常用策略。在咨询模式中，儿科重症监护病房（PICU）团队、患者或其家属必须请求外部姑息治疗（PC）团队对PICU患者进行会诊，以便评估其特殊护理需求。虽然咨询模式在历史上更受欢迎，但与专科医生可用性、转诊时机、工作人员的个人偏见、对PC的误解以及其他因素相关的问题可能会阻碍优秀的患者及时获得他们所需的关注。相比之下，在IMOC中，以家庭为中心的护理、PC任务和/或PC是所有患者均可自动获得的标准治疗组成部分。在IMOC中，PICU团队接受培训，将完成关键和PC任务作为日常正常工作的一部分。本综述调查了IMOC是满足PICU广泛PPC需求的最佳模式这一说法，特别是在资源匮乏的环境中；基于对文献的广泛综述，我们确定了该模式可能更具优势的五个原因。IMOC似乎：（1）改善PPC和儿科重症护理的提供，（2）使临床医生能够以符合循证建议的方式更好地应对患者的护理需求及其所处环境的流行病学现实，（3）促进为所有有特殊护理需求的患者普遍提供护理，（4）最大限度地利用可用资源，以及（5）建设当地能力；这些领域中的每一个都应进一步研究，以开发一种护理模式，使临床医生能够为儿科患者提供可达到的最高医疗保健标准。IMOC为世界上病情最严重、最脆弱的儿童提供了获得PPC的途径，这是他们根据国际法律公约应享有的一项人权。
