Palliative Care Unit, Montpied Hospital, University Hospital of Clermont-Ferrand, 54 rue Montalembert, BP69, 63003, Clermont-Ferrand, Cedex 1, France.
Pulmonology Unit, Montpied Hospital, University Hospital of Clermont-Ferrand, Clermont-Ferrand, France.
BMC Palliat Care. 2021 May 17;20(1):68. doi: 10.1186/s12904-021-00755-w.
Deciding to withdraw non-invasive ventilation (NIV) at end-of-life (EOL) in patients with chronic respiratory failure is a challenge. The European Association for Palliative Care recommends not maintaining artificial therapies that could prolong life during palliative sedation (PS) at EOL. The aim of this survey was to assess palliative care physicians' and pulmonologists' opinion on withdrawing or maintaining NIV in patients with chronic respiratory failure during PS at EOL.
From April to May 2019, we performed a prospective survey among pulmonologists (n = 1545) and palliative care physicians (n = 631) in France to determine the prevalence of opinion in favour of maintaining NIV and identify the factors associated with opinion in favour of withdrawing or maintaining NIV with multiple logistic regression.
A total of 457 participants were enrolled comprising 202 pulmonologists and 255 palliative care physicians. An opinion in favour of maintaining NIV was found in 88 (19.3 95%CI [15.7; 23.2]) physicians comprising 57 (28.2%) pulmonologists and 31 (12.2%) palliative care physicians (p < 0.001). The factors associated with an opinion in favour of maintaining NIV were spending time looking for advanced directives (AD) in the patient's file (odds ratio (OR): 6.54, 95%CI [2.00; 21.32], p = 0.002) and personal ethics of physicians (OR: 17.97, 95%CI [9.52; 33.89], p < 0.001). The factor associated with an opinion in favour of withdrawing NIV was palliative care training (OR: 0.31, 95%CI [0.16; 0.60], p < 0.001). The three main reasons in favour of maintaining NIV among the nine identified were emotional comfort for close relatives, reducing discomfort of dyspneoa and anticipation of suffocation.
In France, around 20% of pulmonologists and palliative care physicians declared an opinion in favour of maintaining NIV during PS at EOL because of their personal ethics and spending time looking for AD, if any, in the patient's file. Palliative care training can stimulate reflection help foster a change of opinion about practices, especially in the case of patients with NIV during PS at EOL.
在终末期（EOL）慢性呼吸衰竭患者中决定停止使用无创通气（NIV）是一个挑战。欧洲姑息治疗协会建议，在 EOL 姑息镇静期间，不要维持可能延长生命的人工治疗。这项调查的目的是评估姑息治疗医生和肺病专家对 EOL 姑息镇静期间慢性呼吸衰竭患者停止或维持 NIV 的意见。
2019 年 4 月至 5 月，我们在法国对 1545 名肺病专家和 631 名姑息治疗医生进行了前瞻性调查，以确定赞成维持 NIV 的意见的流行率，并通过多变量逻辑回归确定与赞成停止或维持 NIV 的意见相关的因素。
共纳入 457 名参与者，包括 202 名肺病专家和 255 名姑息治疗医生。88 名（19.3%95%CI[15.7%；23.2%]）医生表示赞成维持 NIV，其中 57 名（28.2%）为肺病专家，31 名（12.2%）为姑息治疗医生（p<0.001）。赞成维持 NIV 的意见相关的因素包括在患者病历中寻找高级指令（AD）的时间（优势比（OR）：6.54，95%CI[2.00；21.32]，p=0.002）和医生的个人伦理（OR：17.97，95%CI[9.52；33.89]，p<0.001）。赞成停止 NIV 的意见相关的因素是姑息治疗培训（OR：0.31，95%CI[0.16；0.60]，p<0.001）。在确定的 9 个赞成维持 NIV 的主要原因中，有 3 个是为近亲提供情感安慰、减少呼吸困难不适和避免窒息。
在法国，约 20%的肺病专家和姑息治疗医生表示，由于个人伦理和在患者病历中寻找 AD（如果有的话）的时间，他们赞成在 EOL 姑息镇静期间维持 NIV。姑息治疗培训可以促进思考，有助于改变对实践的看法，特别是在 EOL 姑息镇静期间接受 NIV 的患者。
