8569例创伤患者生命维持治疗的 withhold 与撤除：一项多中心分析注册研究
Withholding and withdrawal of life-sustaining therapy in 8569 trauma patients: A multicentre, analytical registry study.
作者信息
Haddam Malik, Kubacsi Laura, Hamada Sophie, Harrois Anatole, James Arthur, Langeron Olivier, Boutonnet Mathieu, Holleville Mathilde, Garrigue Delphine, Leclercq Marion, Hanouz Jean-Luc, Pottecher Julien, Audibert Gérard, Cardinale Mickael, Vinour Hélène, Zieleskiewicz Laurent, Resseguier Noemie, Leone Marc
机构信息
From the Aix Marseille University, Assistance Publique Hôpitaux de Marseille, Department of Anaesthesia and Intensive Care, Hôpital Nord (MH, LK, LZ, ML), Support Unit for Clinical Research and Economic Evaluation, Assistance Publique-Hôpitaux de Marseille - CERESS, Aix Marseille University, Marseille (NR), Kremlin Bicêtre University Hospital, Assistance Publique Hôpitaux de Paris, Department of Anaesthesia and Intensive Care, Le Kremlin-Bicêtre (AH), Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Pitié Salpêtrière University Hospital (AJ), Department of Anaesthesia and Intensive Care, Assistance Publique Hôpitaux de Paris, Hôpital Européen Georges Pompidou University Hospital, Paris (SH, ML), Department of Anaesthesia and Intensive Care, Henri Mondor University Hospital, Assistance Publique Hôpitaux de Paris, Créteil (OL), Department of Anaesthesiology and Critical Care Medicine, DMU Parabol, Beaujon Hospital, APHP. Nord-Université de Paris, 100 Bd du General Leclerc 92110 Clichy (MHo), Department of Anaesthesia and Intensive Care, Clamart Army Training Hospital Percy, Clamart (MB), Toulon Army Training Hospital Sainte-Anne, Toulon (MC), Department of Anaesthesia and Intensive Care, Toulouse University Hospital, Toulouse (HV), Department of Anesthesia and Critical Care Medicine, Université de Lorraine, CHRU Nancy, Nancy (GA), Lille University Hospital, Pôle de l'Urgence, Pôle d'Anesthésie Réanimation, Lille (DG), Department of Anaesthesia and Intensive Care, Reims University Hospital, Reims (MLec), Department of Anaesthesia and Intensive Care, Caen University Hospital, Caen (JLH) and Department of Anaesthesia and Perioperative Medicine, Strasbourg University Hospital, Strasbourg, France (JP).
出版信息
Eur J Anaesthesiol. 2022 May 1;39(5):418-426. doi: 10.1097/EJA.0000000000001671. Epub 2022 Feb 14.
BACKGROUND
This study aimed to determine the prevalence of withholding or withdrawal of life-sustaining therapy (WLST) decisions in trauma ICU patients, using a large registry. We hypothesised that this prevalence is similar to that of the general population admitted to an ICU. As secondary aims, it sought to describe the trauma patients for whom the decision was made for WLST and the factors associated with this decision.
DESIGN
This observational study assessed data from 14 French centres listed in the TraumaBaseTM registry. All trauma patients hospitalised for more than 48 h were pro-spectively included.
RESULTS
Data from 8569 trauma patients, obtained from January 2016 to December 2018, were included in this study. A WLST decision was made in 6% of all cases. In the WLST group, 67% of the patients were older men (age: 62 versus 36, P < 0.001); more often they had a prior medical history and higher median severity scores than the patients in the no WLST decision group; SAPS II 58 (46 to 69) versus 21 (13 to 35) and ISS 26 (22 to 24) versus 12 (5 to 22), P < 0.001. Neurological status was strongly associated with WLST decisions. The geographic area of the ICUs affected the rate of the WLST decisions. The ICU mortality was 11% (n = 907) of which 47% (n = 422) were preceded by WLST decisions. Fourteen percent of WLST orders were not associated to the death.
CONCLUSION
Among 8569 patients, medical history, trauma severity criteria, notably neurological status and geographical areas were associated with WLST. These regional differences deserve to be investigated in future studies.
背景
本研究旨在通过一个大型登记系统，确定创伤重症监护病房（ICU）患者中维持生命治疗（WLST）决策的预扣或撤销情况。我们假设这一比例与入住ICU的普通人群相似。作为次要目标，本研究试图描述做出WLST决策的创伤患者以及与此决策相关的因素。
设计
这项观察性研究评估了TraumaBaseTM登记系统中列出的14个法国中心的数据。所有住院超过48小时的创伤患者均被前瞻性纳入。
结果
本研究纳入了2016年1月至2018年12月期间8569例创伤患者的数据。所有病例中有6%做出了WLST决策。在WLST组中，67%的患者为老年男性（年龄：62岁对36岁，P<0.001）；与未做出WLST决策的患者相比，他们更常患有既往病史且中位严重程度评分更高；序贯器官衰竭评估（SAPS）II评分分别为58（46至69）和21（13至35），损伤严重度评分（ISS）分别为26（22至24）和12（5至22），P<0.001。神经状态与WLST决策密切相关。ICU的地理位置影响了WLST决策的比例。ICU死亡率为11%（n = 907），其中47%（n = 422）在死亡前做出了WLST决策。14%的WLST医嘱与死亡无关。
结论
在8569例患者中，病史、创伤严重程度标准，尤其是神经状态和地理位置与WLST相关。这些地区差异值得在未来的研究中进行调查。
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