Del Olmo Francisco, Otero Yomayra, Flores Juan, Aleman Jesse, Rodríguez-Cintrón William
VA Caribbean Healthcare System, San Juan, Puerto Rico.
P R Health Sci J. 2019 Mar;38(1):3-7.
To document (using available data) the profile of the patients seen by the hospital's palliative service (PS) and who died in the medicine intensive care unit (ICU) of the Veterans Affairs Caribbean Healthcare System.
A record review of subjects who died in the ICU from January 1, 2012, to December 31, 2014. Demographic data, underlying comorbidities, the cause of death, the length of stay, evaluation made by the PS, and the withdrawal of life support (when such occurred) were recorded for each patient.
A total of 200 patients met the criteria, mostly males. All the women and 50% of the men were over 79 years old. Seventy three percent of the patients were on mechanical ventilation when admitted, most having come from the emergency department. Fewer than 15% had advance directives. Forty-nine percent had been admitted to a hospital facility at least once during the year prior to their current admission. Most of the patients (60.5%) died within the first week, while 13% died within the first 24 hours. PS was requested for 56% of those who survived more than 24 hours, of which only 10% underwent the withdrawal-of-care protocol.
A small percentage of the patients who died in the ICU had advance directives at the time of admission, this though all were of advanced age, had recently been discharged after a prior hospital stay, suffered from 1 or more chronic illnesses, or had a history of mental or physical disease. Our findings underscore the need for the early referral of patients of the type previously mentioned to a PS.
利用现有数据记录在退伍军人事务加勒比医疗系统内科重症监护病房（ICU）死亡的、曾接受医院姑息治疗服务（PS）的患者情况。
对2012年1月1日至2014年12月31日期间在ICU死亡的患者记录进行回顾。记录每名患者的人口统计学数据、基础合并症、死亡原因、住院时间、PS评估以及生命支持撤除情况（若有）。
共有200名患者符合标准，大多数为男性。所有女性及50%的男性年龄超过79岁。73%的患者入院时接受机械通气，多数来自急诊科。不到15%的患者有预先指示。49%的患者在本次入院前一年至少有一次住院史。大多数患者（60.5%）在第一周内死亡，13%在最初24小时内死亡。超过24小时存活的患者中有56%请求了PS，其中只有10%接受了撤除治疗方案。
在ICU死亡的患者中，入院时有预先指示的比例较小，尽管所有患者均为高龄、近期曾住院后出院、患有1种或多种慢性病，或有精神或身体疾病史。我们的研究结果强调需要将上述类型的患者尽早转诊至PS。
