Piscitello Gina M, Parham William M, Huber Michael T, Siegler Mark, Parker William F
1 Department of Medicine, University of Chicago, Chicago, IL, USA.
2 MacLean Center for Clinical Medical Ethics, University of Chicago, Chicago, IL, USA.
Am J Hosp Palliat Care. 2019 Dec;36(12):1049-1056. doi: 10.1177/1049909119843133. Epub 2019 Apr 14.
Family meetings in the medical intensive care unit can improve outcomes. Little is known about when meetings occur in practice. We aimed to determine the time from admission to family meetings in the medical intensive care unit and assess the relationship of meetings with mortality.
We performed a prospective cohort study of critically ill adult patients admitted to the medical intensive care unit at an urban academic medical center. Using manual chart review, the primary outcome was any attempt at holding a family meeting within 72 hours of admission. Competing risk models estimated the time from admission to family meeting and to patient death or discharge.
Of the 131 patients who met inclusion criteria in the 12-month study period, the median time from admission to family meeting was 4 days. Fewer than half of patients had a documented family meeting within 72 hours of admission (n = 60/131, 46%), with substantial interphysician variability in meeting rates ranging from 28% to 63%. Patients with family meetings within 72 hours were 30 times more likely to die within 72 hours (32% vs 1%, < .001). Of the 55 patients who died in the intensive care unit, 27 (49%) had their first family meeting within 1 day of death.
Family meetings occur considerably later than 72 hours and are often held in close proximity to a patient's death. This suggests for some physicians, family meetings may primarily be used to negotiate withdrawal of life support rather than to support the patient and family.
在医疗重症监护病房召开家属会议可改善治疗结果。但在实际中会议何时召开却鲜为人知。我们旨在确定入住医疗重症监护病房后至召开家属会议的时间，并评估会议与死亡率之间的关系。
我们对一家城市学术医疗中心收治到医疗重症监护病房的成年危重症患者进行了一项前瞻性队列研究。通过人工查阅病历，主要结局是在入院72小时内是否尝试召开家属会议。竞争风险模型估计了从入院到召开家属会议以及到患者死亡或出院的时间。
在为期12个月的研究期间符合纳入标准的131例患者中，从入院到召开家属会议的中位时间为4天。不到一半的患者在入院72小时内有记录显示召开了家属会议（n = 60/131，46%），医生之间的会议率差异很大，范围从28%到63%。在72小时内召开家属会议的患者在72小时内死亡的可能性是其他患者的30倍（32%对1%，P <.001）。在重症监护病房死亡的55例患者中，有27例（49%）在死亡1天内召开了首次家属会议。
家属会议的召开时间比72小时晚得多，而且通常在患者死亡前不久举行。这表明对于一些医生来说，家属会议可能主要用于协商撤除生命支持，而不是支持患者及其家属。
