儿童心脏病患者 ICU 治疗中的姑息治疗。
Palliative Care in Children With Heart Disease Treated in an ICU.
机构信息
Division of Critical Care, Department of Pediatrics, University of Utah, Salt Lake City, UT.
Pediatric Critical Care Services, Primary Children's Hospital, Intermountain Healthcare, Salt Lake City, UT.
出版信息
Pediatr Crit Care Med. 2020 May;21(5):423-429. doi: 10.1097/PCC.0000000000002271.
OBJECTIVES
Describe pediatric palliative care consult in children with heart disease; retrospectively apply Center to Advance Palliative Care criteria for pediatric palliative care consults; determine the impact of pediatric palliative care on end of life.
DESIGN
A retrospective single-center study.
SETTING
A 16-bed cardiac ICU in a university-affiliated tertiary care children's hospital.
PATIENTS
Children (0-21 yr old) with heart disease admitted to the cardiac ICU from January 2014 to June 2017.
MEASUREMENTS AND MAIN RESULTS
Over 1,000 patients (n = 1, 389) were admitted to the cardiac ICU with 112 (8%) receiving a pediatric palliative care consultation. Patients who received a consult were different from those who did not. Patients who received pediatric palliative care were younger at first hospital admission (median 63 vs 239 d; p = 0.003), had a higher median number of complex chronic conditions at the end of first hospitalization (3 vs 1; p < 0.001), longer cumulative length of stay in the cardiac ICU (11 vs 2 d; p < 0.001) and hospital (60 vs 7 d; p < 0.001), and higher mortality rates (38% vs 3%; p < 0.001). When comparing location and modes of death, patients who received pediatric palliative care were more likely to die at home (24% vs 2%; p = 0.02) and had more comfort care at the end of life (36% vs 2%; p = 0.002) compared to those who did not. The Center to Advance Palliative Care guidelines identified 158 patients who were eligible for pediatric palliative care consultation; however, only 30 patients (19%) in our sample received a consult.
CONCLUSIONS
Pediatric palliative care consult rarely occurred in the cardiac ICU. Patients who received a consult were medically complex and experienced high mortality. Comfort care at the end of life and death at home was more common when pediatric palliative care was consulted. Missed referrals were apparent when Center to Advance Palliative Care criteria were retrospectively applied.
目的
描述儿科姑息治疗咨询在心脏病患儿中的应用；回顾性应用推进姑息治疗中心的儿科姑息治疗咨询标准；确定儿科姑息治疗对临终关怀的影响。
设计
回顾性单中心研究。
地点
一家大学附属的三级儿童专科医院的 16 张床位的心脏重症监护病房。
患者
2014 年 1 月至 2017 年 6 月期间入住心脏重症监护病房的 0-21 岁心脏病患儿（n=1389）。
测量和主要结果
超过 1000 名患者（n=1000）入住心脏重症监护病房，其中 112 名（8%）接受了儿科姑息治疗咨询。接受咨询的患者与未接受咨询的患者不同。接受儿科姑息治疗的患者首次住院时年龄更小（中位数 63 天 vs 239 天；p=0.003），首次住院时患有更复杂的慢性疾病（中位数 3 种 vs 1 种；p<0.001），心脏重症监护病房和医院的累计住院时间更长（中位数 11 天 vs 2 天；p<0.001 和中位数 60 天 vs 7 天；p<0.001），死亡率更高（38% vs 3%；p<0.001）。比较死亡地点和方式，接受儿科姑息治疗的患者更有可能在家中死亡（24% vs 2%；p=0.02），临终时接受更多的舒适护理（36% vs 2%；p=0.002）。推进姑息治疗中心的指南确定了 158 名符合儿科姑息治疗咨询条件的患者，但在我们的样本中，只有 30 名患者（19%）接受了咨询。
结论
儿科姑息治疗咨询在心脏重症监护病房中很少发生。接受咨询的患者病情复杂，死亡率高。当进行儿科姑息治疗咨询时，临终关怀和在家中死亡更为常见。当回顾性应用推进姑息治疗中心的标准时，明显存在漏诊。
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