Igarashi Yuko, Tanaka Yuta, Ito Kaori, Miyashita Mitsunori, Kinoshita Satomi, Kato Akane, Kizawa Yoshiyuki
Department of Palliative Medicine, Kobe University Graduate School of Medicine, 7-5-1 Kusunokicho, Chuo-ku, Kobe, Hyogo, 650-0017, Japan.
Department of Palliative Nursing, Health Sciences, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8575, Japan.
J Intensive Care. 2022 Mar 18;10(1):18. doi: 10.1186/s40560-022-00605-8.
It is currently unknown how widespread is the practice of palliative care in intensive care units (ICUs) in Japan. This study aimed to determine evaluate the delivery and self-reported practice of palliative care in ICUs in Japan.
A self-administered questionnaire was sent to the physician directors of all 873 ICUs in Japan in August 2020.
Of the 873 institutions, 439 responded the questionnaire (response rate: 50%) and 413 responses were included in the analysis. The responding physicians thought palliative care was appropriate for physical symptoms (36%, 95% Confidence Interval [CI] 32-41), the provision of information (32%, 95% CI: 28-37), psychological distress (25%, 95% CI: 21-29) and in Post Intensive Care Syndrome (PICS) prevention (20%, 95% CI: 17-24). Only 4% (95% CI: 2-6) of participants indicated that they always provided palliative care screening for the patients admitted to the ICU. The most common method to determine eligibility for palliative care was the "prediction of prognosis by clinician's experience" (54%, 95% CI: 50-59). Thirty-one percent (95% CI: 27-36) of participants responded that there was no clear method used to decide which patients need palliative care. Fifty-four percent of the participants answered they had no standardized protocols for symptom management at all. Less than 5% answered they had standardized protocols for end-of-life symptom management or terminal weaning off mechanical ventilation including extubation of endotracheal tubes.
In Japan, the dissemination of palliative care and its integration into ICU care appears insufficient. To improve the quality of life of patients who are admitted to ICU, it may be useful to implement palliative care screening and multidisciplinary conferences, to develop standardized protocols for symptom management and withholding or withdrawing of life-sustaining treatment, and to educate primary palliative care for all ICU physicians.
目前尚不清楚日本重症监护病房（ICU）中姑息治疗的普及程度。本研究旨在确定并评估日本ICU中姑息治疗的实施情况及自我报告的实践情况。
2020年8月，向日本所有873个ICU的主任医生发送了一份自填式问卷。
873家机构中，439家回复了问卷（回复率：50%），413份回复纳入分析。回复问卷的医生认为姑息治疗适用于身体症状（36%，95%置信区间[CI]32 - 41）、信息提供（32%，95%CI：28 - 37）、心理困扰（25%，95%CI：21 - 29）以及预防重症监护后综合征（PICS，20%，95%CI：17 - 24）。只有4%（95%CI：2 - 6）的参与者表示他们总是对入住ICU的患者进行姑息治疗筛查。确定姑息治疗资格的最常见方法是“根据临床医生的经验预测预后”（54%，95%CI：50 - 59）。31%（95%CI：27 - 36）的参与者回复称没有明确的方法来决定哪些患者需要姑息治疗。54%的参与者回答他们根本没有症状管理的标准化方案。不到5%的人回答他们有终末期症状管理或终止机械通气（包括气管插管拔管）的标准化方案。
在日本，姑息治疗的传播及其与ICU护理的整合似乎不足。为提高入住ICU患者的生活质量，实施姑息治疗筛查和多学科会议、制定症状管理以及维持或撤销生命维持治疗的标准化方案，以及对所有ICU医生进行初级姑息治疗教育可能会有所帮助。
