Sheehan Jacqueline, Ho Kam Sing, Poon Joseph, Sarosky Kimberly, Fung Jennifer Y
Department of Medicine, Mount Sinai Morningside & Mount Sinai West, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA
Department of Medicine, Mount Sinai Morningside & Mount Sinai West, Icahn School of Medicine at Mount Sinai, Mount Sinai Health System, New York, New York, USA.
BMJ Support Palliat Care. 2023 Mar;13(1):107-111. doi: 10.1136/bmjspcare-2020-002677. Epub 2020 Dec 2.
The COVID-19 pandemic in the USA has been accompanied by high rates of mortality and an unprecedented need for palliative care delivery. Little is known about the use of palliative care services in intensive care unit (ICU) settings during the COVID-19 pandemic.
This is a retrospective cohort study of critically ill COVID-19 patients requiring ICU admission, between 7 March and 14 April 2020 to two academic teaching hospitals in New York City. Palliative care consultation included a one-time telemedicine consultation or continued telemedicine consultation and follow-up with multidisciplinary team involvement. Patient information was collected from the electronic health record and analyses were conducted with Stata V.15.1 (StataCorp) statistical software.
A total of 151 critically ill patients with COVID-19 pneumonia requiring ICU admission were identified, of whom 59 (39.07%) received an inpatient palliative care consultation. More than half of patients died (n=85/151, 56.29%), with 57.65% (n=49/85) of these patients receiving palliative care services during their hospitalisation. Patients who received palliative care consultation were more likely to be older, sicker and receive mechanical ventilation than their counterparts. Patients who died and did not receive palliative care were younger and required non-invasive ventilation support.
There is a lack of utilisation of palliative care in COVID-19 patients admitted to the ICU. Further research into predictors of poor outcomes in critically ill COVID-19 patients may help identify patients that would benefit from early palliative care involvement going forward.
美国的新冠疫情伴随着高死亡率以及对姑息治疗前所未有的需求。对于新冠疫情期间重症监护病房（ICU）环境下姑息治疗服务的使用情况，人们知之甚少。
这是一项回顾性队列研究，研究对象为2020年3月7日至4月14日期间入住纽约市两家学术教学医院、需要入住ICU的重症新冠患者。姑息治疗会诊包括一次性远程医疗会诊或持续的远程医疗会诊，并由多学科团队参与随访。从电子健康记录中收集患者信息，并使用Stata V.15.1（StataCorp）统计软件进行分析。
共确定了151例需要入住ICU的重症新冠肺炎患者，其中59例（39.07%）接受了住院姑息治疗会诊。超过一半的患者死亡（n = 85/151，56.29%），其中57.65%（n = 49/85）的患者在住院期间接受了姑息治疗服务。接受姑息治疗会诊的患者比未接受会诊的患者年龄更大、病情更严重，且更有可能接受机械通气。死亡且未接受姑息治疗的患者更年轻，需要无创通气支持。
入住ICU的新冠患者对姑息治疗的利用率较低。对重症新冠患者不良结局预测因素的进一步研究可能有助于确定未来将从早期姑息治疗参与中获益的患者。
