Department of Anaesthesiology and Operative Intensive Care Medicine (CCM, CVK) Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Berlin Institute of Health (BIH), Charitéplatz 1, 10117 Berlin, Germany.
Medicina (Kaunas). 2021 Sep 4;57(9):930. doi: 10.3390/medicina57090930.
: Mortality on Intensive Care Units (ICUs) is high and death frequently occurs after decisions to limit life-sustaining therapies. An advance directive is a tool meant to preserve patient autonomy by guiding anticipated future treatment decisions once decision-making capacity is lost. Since September 2009, advance directives are legally binding for the caregiver team and the patients' surrogate decision-maker in Germany. The change in frequencies of end-of-life decisions (EOLDs) and completed advance directives among deceased ICU patients ten years after the enactment of a law on advance directives in Germany is unknown. : Retrospective analysis on all deceased patients of surgical ICUs of a German university medical center from 08/2008 to 09/2009 and from 01/2019 to 09/2019. Frequency of EOLDs and advance directives and the process of EOLDs were compared between patients admitted before and after the change in legislation. (No. of ethical approval EA2/308/20) Significantly more EOLDs occurred in the 2019 cohort compared to the 2009 cohort (85.8% vs. 70.7% of deceased patients, = 0.006). The number of patients possessing an advance directive to express a living or therapeutic will was higher in the 2019 cohort compared to the 2009 cohort (26.4% vs. 8.9%; difference: 17.5%, < 0.001). Participation of the patients' family in the EOLD process (74.7% vs. 60.9%; difference: 13.8%, = 0.048) and the frequency of documentation of EOLD-relevant information (50.0% vs. 18.7%; difference: 31.3%, < 0.001) increased from 2009 to 2019. : During a ten-year period from 2009 to 2019, the frequency of EOLDs and the completion rate of advance directives have increased considerably. In addition, EOLD-associated communication and documentation have further improved.
: 重症监护病房 (ICUs) 的死亡率很高，并且经常在决定限制维持生命的治疗后发生死亡。预嘱是一种工具，旨在通过在丧失决策能力后指导预期的未来治疗决策来维护患者的自主权。自 2009 年 9 月以来，在德国，预嘱对护理团队和患者的替代决策者具有法律约束力。自德国颁布预嘱法以来，十年后，关于 ICU 死亡患者的临终决策 (EOLD) 频率和已完成的预嘱的变化尚不清楚。: 这是一项对德国一所大学医学中心外科 ICU 所有死亡患者进行的回顾性分析，时间为 2008 年 8 月至 2009 年 9 月和 2019 年 1 月至 2019 年 9 月。比较了立法变更前后入院患者的 EOLD 频率和预嘱以及 EOLD 流程。（伦理批准编号：EA2/308/20）。2019 年队列中发生 EOLD 的患者明显多于 2009 年队列（85.8%比 70.7%的死亡患者， = 0.006）。2019 年队列中拥有表达生活或治疗意愿的预嘱的患者数量高于 2009 年队列（26.4%比 8.9%；差异：17.5%， < 0.001）。患者家属参与 EOLD 过程（74.7%比 60.9%；差异：13.8%， = 0.048）和记录 EOLD 相关信息的频率（50.0%比 18.7%；差异：31.3%， < 0.001）从 2009 年增加到 2019 年。: 在 2009 年至 2019 年的十年期间，EOLD 频率和预嘱完成率显着增加。此外，EOLD 相关的沟通和文件记录也进一步得到了改善。
