Takaoka Yoshimitsu, Hamatani Yasuhiro, Shibata Tatsuhiro, Oishi Shogo, Utsunomiya Akemi, Kawai Fujimi, Komiyama Nobuyuki, Mizuno Atsushi
Department of Cardiovascular Medicine, St. Luke's International Hospital, 9-1, Akashi-cho, Chuo-ku, Tokyo, Japan.
Department of Cardiology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan.
J Intensive Care. 2022 Mar 14;10(1):15. doi: 10.1186/s40560-022-00607-6.
Healthcare providers working for cardiovascular intensive care often face challenges and they play an essential role in palliative care and end-of-life care because of the high mortality rates in the cardiac intensive care unit. Unfortunately, there are several barriers to integrating palliative care, cardiovascular care, and intensive care. The main reasons are as follows: cardiovascular disease-specific trajectories differ from cancer, there is uncertainty associated with treatments and diagnoses, aggressive treatments are necessary for symptom relief, and there is ethical dilemma regarding withholding and withdrawal of life-sustaining therapy. Quality indicators that can iterate the minimum requirements of each medical discipline could be used to overcome these barriers and effectively practice palliative care in cardiovascular intensive care. Unfortunately, there are no specific quality indicators for palliative care in cardiovascular intensive care. A few indicators and their domains are useful for understanding current palliative care in cardiovascular intensive care. Among them, several domains, such as symptom palliation, patient- and family-centered decision-making, continuity of care, and support for health care providers that are particularly important in cardiovascular intensive care.Historically, the motivation for using quality indicators is to summarize mechanisms for external accountability and verification, and formative mechanisms for quality improvement. Practically, when using quality indicators, it is necessary to check structural indicators in each healthcare service line, screen palliative care at the first visit, and integrate palliative care teams with other professionals. Finally, we would like to state that quality indicators in cardiovascular intensive care could be useful as an educational tool for practicing palliative care, understanding the minimum requirements, and as a basic structure for future discussions.
从事心血管重症监护工作的医护人员常常面临挑战，由于心脏重症监护病房的高死亡率，他们在姑息治疗和临终关怀中发挥着至关重要的作用。不幸的是，将姑息治疗、心血管护理和重症监护相结合存在若干障碍。主要原因如下：心血管疾病的特定病程与癌症不同，治疗和诊断存在不确定性，为缓解症状需要积极治疗，并且在维持生命治疗的 withhold 和 withdrawal 方面存在伦理困境。可以迭代每个医学学科最低要求的质量指标可用于克服这些障碍，并在心血管重症监护中有效地实施姑息治疗。不幸的是，心血管重症监护中没有针对姑息治疗的具体质量指标。一些指标及其领域有助于了解心血管重症监护中当前的姑息治疗情况。其中，几个领域，如症状缓解、以患者和家庭为中心的决策、护理的连续性以及对医护人员的支持，在心血管重症监护中尤为重要。从历史上看，使用质量指标的动机是总结外部问责和核查机制以及质量改进的形成机制。实际上，在使用质量指标时，有必要检查每个医疗服务线的结构指标，在首次就诊时筛查姑息治疗，并将姑息治疗团队与其他专业人员整合。最后，我们想说，心血管重症监护中的质量指标可作为实施姑息治疗、理解最低要求的教育工具，以及作为未来讨论的基本框架。
