Nadkarni Yashna, Kukec Ivana, Gruber Pascale, Jhanji Shaman, Droney Joanne
Critical Care Unit, Anaesthetics Department, Royal Marsden NHS Foundation Trust, London, UK.
University Hospital Centre Zagreb, Zagreb, Croatia.
Support Care Cancer. 2022 Mar;30(3):2173-2181. doi: 10.1007/s00520-021-06542-w. Epub 2021 Oct 26.
Palliative care within intensive care units (ICU) benefits decision-making, symptom control, and end-of-life care. It has been shown to reduce the length of ICU stay and the use of non-beneficial and unwanted life-sustaining therapies. However, it is often initiated late or not at all. There is increasing evidence to support screening ICU patients using palliative care referral criteria or "triggers". The aim of the project was to assess the need for palliative care referral during ICU admission using "trigger" tools.
Electronic record review of cancer patients who died in or within 30 days of discharge from oncology ICU, between 2016 and 2018. Patients referred to palliative care before or during ICU admission were identified. Three sets of palliative care referral "triggers" were applied: one that is being tested locally and two internationally derived tools. The proportion of patients who met any of these triggers during their final ICU admission was calculated.
Records of 149 patients were reviewed: median age 65 (range 20-83). Most admissions (89%) were unplanned, with the most common diagnoses being haemato-oncology (31%) and gastrointestinal (16%) cancers. Most (73%) were unknown to palliative care pre-ICU admission; 44% were referred between admission and death. The median time from referral to death was 0 day (range 0-19). On ICU admission, 97-99% warranted referral to palliative care using locally and internationally derived triggers.
All "trigger" tools identified a high proportion of patients who may have warranted a palliative care referral either before or during admission to ICU. The routine use of trigger tools could help streamline referral pathways and underpin the development of an effective consultative model of palliative care within the ICU setting to enhance decision-making about appropriate treatment and patient-centred care.
重症监护病房（ICU）内的姑息治疗有助于决策制定、症状控制和临终关怀。研究表明，它能缩短ICU住院时间，并减少使用无益处且不必要的维持生命治疗。然而，姑息治疗往往启动过晚或根本未启动。越来越多的证据支持使用姑息治疗转诊标准或“触发因素”对ICU患者进行筛查。该项目的目的是使用“触发因素”工具评估ICU入院期间进行姑息治疗转诊的必要性。
对2016年至2018年间在肿瘤ICU死亡或出院后30天内死亡的癌症患者的电子病历进行回顾。确定在ICU入院前或入院期间被转诊至姑息治疗的患者。应用了三组姑息治疗转诊“触发因素”：一组正在当地进行测试，另外两组是源自国际的工具。计算在其最后一次ICU住院期间符合任何这些触发因素的患者比例。
回顾了149例患者的记录：中位年龄65岁（范围20 - 83岁）。大多数入院（占89%）为非计划性入院，最常见的诊断是血液肿瘤（占31%）和胃肠道（占16%）癌症。大多数患者（占73%）在ICU入院前未接受过姑息治疗；44%的患者在入院至死亡期间被转诊。从转诊到死亡的中位时间为0天（范围0 - 19天）。在ICU入院时，使用源自当地和国际的触发因素，97% - 99%的患者有必要转诊至姑息治疗。
所有“触发因素”工具均识别出很大比例的患者在入住ICU之前或期间可能有必要接受姑息治疗转诊。常规使用触发因素工具有助于简化转诊流程，并为在ICU环境中建立有效的姑息治疗咨询模式奠定基础，以加强关于适当治疗的决策制定和以患者为中心的护理。
