Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, NY, USA.
Center for Research on End-of-Life Care, Weill Cornell Medicine, NY, USA.
Am J Hosp Palliat Care. 2021 Dec;38(12):1509-1515. doi: 10.1177/10499091211005707. Epub 2021 Apr 8.
We know little about the end-of-life suffering and symptoms of intensive care unit (ICU) decedents in general and those who undergo renal replacement therapy (RRT) in particular.
To examine differences in end-of-life suffering and various symptoms' contribution to suffering between ICU decedents who did not undergo RRT, those who underwent RRT for end-stage kidney disease (ESKD), and those who underwent RRT for acute kidney injury (AKI).
This is a cross-sectional study conducted at a quaternary-level referral hospital September 2015-March 2017. Nurses completed interviews about ICU patients' suffering and symptoms in their final week. We dichotomized overall suffering into elevated and non-elevated and each symptom as contributing or not to a patient's suffering.
Sixty-four nurses completed interviews on 165 patients. Median patient age was 67 years (interquartile range 57, 78); 41% were female. In a multivariable model, undergoing RRT for AKI (odds ratio [OR] 2.95, 95% confidence interval [CI] 1.34-6.49) was significantly associated with elevated suffering compared to no RRT; undergoing RRT for ESKD was not. Adjusting for length of stay, AKI-RRT patients were more likely than non-RRT patients to have fecal incontinence (OR 2.21, 95% CI 1.00-4.93), painful broken skin (OR 2.41, 95% CI 1.14-5.12), and rashes (OR 3.61, 95% CI 1.35-9.67) contributing to their suffering.
Undergoing RRT for AKI was associated with elevated suffering in the last week of life in ICU decedents. Painful broken skin, rashes, and fecal incontinence were more likely to contribute to suffering in AKI-RRT patients than in non-RRT patients. How to reduce suffering associated with AKI-RRT in ICU patients merits further study.
我们对重症监护病房（ICU）死亡患者的终末期痛苦和症状知之甚少，特别是那些接受肾脏替代治疗（RRT）的患者。
研究未接受 RRT、因终末期肾脏疾病（ESKD）接受 RRT 和因急性肾损伤（AKI）接受 RRT 的 ICU 死亡患者之间终末期痛苦和各种症状对痛苦的贡献的差异。
这是一项在 2015 年 9 月至 2017 年 3 月期间在一家四级转诊医院进行的横断面研究。护士在 ICU 患者最后一周完成有关患者痛苦和症状的访谈。我们将整体痛苦分为升高和不升高，并将每个症状分为对患者痛苦有贡献和没有贡献。
64 名护士对 165 名患者进行了访谈。患者的中位年龄为 67 岁（四分位距 57，78）；41%为女性。在多变量模型中，与未接受 RRT 的患者相比，因 AKI 接受 RRT（比值比 [OR] 2.95，95%置信区间 [CI] 1.34-6.49）与升高的痛苦显著相关；因 ESKD 接受 RRT 则不然。调整入住时间后，与非 RRT 患者相比，AKI-RRT 患者更有可能出现粪便失禁（OR 2.21，95% CI 1.00-4.93）、疼痛性皮肤破损（OR 2.41，95% CI 1.14-5.12）和皮疹（OR 3.61，95% CI 1.35-9.67）导致他们的痛苦。
因 AKI 接受 RRT 与 ICU 死亡患者生命最后一周的升高的痛苦有关。疼痛性皮肤破损、皮疹和粪便失禁更有可能导致 AKI-RRT 患者的痛苦比非 RRT 患者更严重。如何减少 ICU 患者因 AKI-RRT 而导致的痛苦值得进一步研究。
