Department of Intensive Care Medicine, University Medical Center Utrecht, Utrecht University, The Netherlands.
Department of Medical Humanities, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, The Netherlands.
J Crit Care. 2019 Jun;51:39-45. doi: 10.1016/j.jcrc.2019.01.029. Epub 2019 Jan 30.
Many patients in the Intensive Care Unit (ICU) die after a decision to withhold or withdraw treatment. To ensure that for each patient the appropriate decision is taken, a careful decision-making process is required. This review identifies strategies that can be used to optimize the decision-making process for continuing versus limiting life sustaining treatment of ICU patients.
We conducted a systematic review of the literature by searching PUBMED and EMBASE.
Thirty-two studies were included, with five categories of decision-making strategies (1) integrated communication, (2) consultative communication, (3) ethics consultation, (4) palliative care consultation and (5) decision aids. Many different outcome measures were used and none of them covered all aspects of decisions on continuing versus limiting life sustaining treatment. Integrated communication strategies had a positive effect on multiple outcome measures. Frequent, predefined family-meetings as well as triggered and integrated ethical or palliative consultation were able to reduce length of stay of patients who eventually died, without increasing overall mortality.
The decision-making process in the ICU can be enhanced by frequent family-meetings with predefined topics. Ethical and palliative support is useful in specific situations. These interventions can reduce non-beneficial ICU treatment days.
许多在重症监护病房（ICU）的患者在决定停止或撤回治疗后死亡。为确保为每位患者做出适当的决策，需要进行仔细的决策过程。本综述确定了可用于优化继续与限制 ICU 患者维持生命治疗的决策过程的策略。
我们通过搜索 PUBMED 和 EMBASE 进行了系统的文献回顾。
共纳入 32 项研究，分为五类决策策略：（1）综合沟通，（2）咨询沟通，（3）伦理咨询，（4）姑息治疗咨询，（5）决策辅助。使用了许多不同的结果衡量标准，没有一个标准涵盖了继续与限制维持生命治疗的决策的所有方面。综合沟通策略对多个结果衡量标准有积极影响。频繁的、预先设定的家庭会议，以及触发和综合的伦理或姑息治疗咨询，能够减少最终死亡患者的住院时间，而不会增加总死亡率。
通过定期的、预先设定主题的家庭会议，可以增强 ICU 中的决策过程。在特定情况下，伦理和姑息治疗支持是有用的。这些干预措施可以减少无益的 ICU 治疗天数。
