Service de Médecine Intensive-Réanimation, CHU Dijon-Bourgogne, Bourgogne, France.
INSERM, CIC 1432, Module Epidémiologie Clinique, Dijon, France.
PLoS One. 2023 Feb 2;18(2):e0279939. doi: 10.1371/journal.pone.0279939. eCollection 2023.
In a nationwide survey of practices, we sought to define the criteria, circumstances and consequences of non-beneficial admissions to the intensive care unit (ICU), with a view to proposing measures to avoid such situations.
ICU physicians from a French research in ethics network participated in an online survey. The first part recorded age, sex, and years' experience of the participants. In the second part, there were 8 to 12 proposals on each of 4 main domains: (1) What criteria could be used to qualify an ICU stay as non-beneficial? (2) What circumstances result in the admission of a patient whose ICU stay may later be deemed non-beneficial? (3) What are the consequences of a non-beneficial stay in the ICU? (4) What measures could be implemented to avoid admissions that later come to be considered as non-beneficial? Responses were on a 5-point Likert scale ranging from "Strongly disagree" to "Strongly agree".
Among 164 physicians contacted, 154 (94%) responded. The majority cited several criteria used to qualify a stay as non-beneficial. Similarly, >80% cited several possible circumstances that could result in non-beneficial admissions, including lack of knowledge of the case and the patient's history, and failure to anticipate acute deterioration. Possible consequences of non-beneficial stays included stress and anxiety for the patient/family, misunderstandings and conflict. Discussing the utility of possible ICU admission in the framework of the patient's overall healthcare goals was hailed as a means to prevent non-beneficial admissions.
The results of this survey suggest that joint discussions should take place during the patient's healthcare trajectory, before the acute need for ICU arises, with a view to limiting or avoiding ICU stays that may later come to be deemed "non-beneficial".
在一项全国性的实践调查中，我们旨在确定将患者收入重症监护病房（ICU）但治疗无益的标准、情况和后果，以便提出避免这种情况的措施。
法国伦理研究网络的 ICU 医生参与了一项在线调查。第一部分记录了参与者的年龄、性别和从业年限。第二部分针对 4 个主要领域的每个领域提出了 8 到 12 个建议：（1）哪些标准可用于确定 ICU 入住无益？（2）哪些情况导致患者入住 ICU，但后来被认为无益？（3）ICU 无益入住的后果是什么？（4）可以采取哪些措施避免后来被认为无益的入院？回答采用 5 分李克特量表，范围从“强烈不同意”到“强烈同意”。
在联系的 164 名医生中，有 154 名（94%）做出了回应。大多数医生引用了一些用于确定入住无益的标准。同样，超过 80%的医生引用了可能导致无益入住的几种情况，包括对病例和患者病史的了解不足，以及未能预测急性恶化。无益入住的可能后果包括患者/家属的压力和焦虑、误解和冲突。在患者整体医疗保健目标的框架内讨论可能的 ICU 入院的效用被认为是预防无益入院的一种手段。
这项调查的结果表明，应该在患者的医疗保健轨迹中进行联合讨论，在 ICU 急性需求出现之前进行讨论，以限制或避免后来被认为“无益”的 ICU 入住。
