Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, California; Critical Care Medicine, Department of Anesthesia (A.C.C., J.C.), University of California San Francisco, San Francisco, California.
Division of Palliative Medicine, Department of Medicine (A.C.C., J.A.L., J.L., D.L.O.R., S.Z.P.), University of California San Francisco, San Francisco, California; Department of Surgery (A.C.C., J.A.L.), University of California San Francisco, San Francisco, California.
J Pain Symptom Manage. 2022 Jun;63(6):e611-e619. doi: 10.1016/j.jpainsymman.2022.03.011.
Palliative care (PC) benefits critically ill patients but remains underutilized. Important to developing interventions to overcome barriers to PC in the ICU and address PC needs of ICU patients is to understand how, when, and for which patients PC is provided in the ICU.
Compare characteristics of specialty PC consultations in the ICU to those on medical-surgical wards.
Retrospective analysis of national Palliative Care Quality Network data for hospitalized patients receiving specialty PC consultation January 1, 2013 to December 31, 2019 in ICU or medical-surgical setting. 98 inpatient PC teams in 16 states contributed data. Measures and outcomes included patient characteristics, consultation features, process metrics and patient outcomes. Mixed effects multivariable logistic regression was used to compare ICU and medical-surgical units.
Of 102,597 patients 63,082 were in medical-surgical units and 39,515 ICU. ICU patients were younger and more likely to have non-cancer diagnoses (all P < 0.001). While fewer ICU patients were able to report symptoms, most patients in both groups reported improved symptoms. ICU patients were more likely to have consultation requests for GOC, comfort care, and withdrawal of interventions and less likely for pain and/or symptoms (OR-all P < 0.001). ICU patients were less often discharged alive.
ICU patients receiving PC consultation are more likely to have non-cancer diagnoses and less likely able to communicate. Although symptom management and GOC are standard parts of ICU care, specialty PC in the ICU is often engaged for these issues and results in improved symptoms, suggesting routine interventions and consultation targeting these needs could improve care.
姑息治疗（PC）有益于危重症患者，但利用率仍然较低。为了开发干预措施以克服 ICU 中 PC 的障碍并满足 ICU 患者的 PC 需求，重要的是要了解在 ICU 中何时以及为哪些患者提供专业 PC 咨询。
比较 ICU 中的专业 PC 咨询与内科-外科病房的特征。
对 2013 年 1 月 1 日至 2019 年 12 月 31 日期间在 ICU 或内科-外科环境中接受专业 PC 咨询的住院患者的全国姑息治疗质量网络数据进行回顾性分析。来自 16 个州的 98 个住院 PC 团队提供了数据。测量和结果包括患者特征、咨询特征、过程指标和患者结果。使用混合效应多变量逻辑回归比较 ICU 和内科-外科病房。
在 102597 名患者中，63082 名在内科-外科病房，39515 名在 ICU。ICU 患者年龄较小，更有可能患有非癌症诊断（均 P < 0.001）。虽然 ICU 患者能够报告症状的人数较少，但两组患者的大多数报告症状都有所改善。ICU 患者更有可能需要 GOC、舒适护理和干预措施的撤回，而不太可能需要疼痛和/或症状的咨询（所有 P < 0.001）。ICU 患者出院时存活的可能性较小。
接受 PC 咨询的 ICU 患者更有可能患有非癌症诊断，并且更难以交流。尽管症状管理和 GOC 是 ICU 护理的标准部分，但 ICU 中的专业 PC 通常用于这些问题，并导致症状改善，这表明针对这些需求的常规干预措施和咨询可以改善护理。
