Lustig Kathrin, Elsner Frank, Krumm Norbert, Klasen Martin, Rolke Roman, Peuckmann-Post Vera
Klinik für Palliativmedizin, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
AIXTRA, Kompetenzzentrum für Training und Patientensicherheit, Medizinische Fakultät, RWTH Aachen University, Aachen, Deutschland.
Anaesthesiologie. 2023 Sep;72(9):627-634. doi: 10.1007/s00101-023-01306-z. Epub 2023 Aug 7.
The transition of patients from the intensive care unit (ICU) to the palliative care (PC) ward often implies changes including establishing a palliative concept. Adaptation of therapeutic goals can be challenging for medical staff, patients and relatives; however, descriptions of these transition trajectories are rare.
The aim of this retrospective study was to characterize the consultation requests of the ICU to the PC consultation team as well as the patients by a description of trajectories and interventions.
Retrospective analysis of all patients receiving intensive care at RWTH Aachen University Hospital in 2019 for whom a PC consultation was requested. The patient population transferred from the ICU to the PC ward was compared with the non-transferred population. In each case, the primary consultation was evaluated regarding the following factors: question, vigilance, length of time from consultation request to its performance, and primary focus of the question. The question focus was categorized into "symptom control", "counselling" and "transfer" (tick options). In addition, a free text field was available for further notes. Exploration of diagnoses was complemented by accessing the electronic health records.
A total of 102 consultation requests from the ICU to the PC ward were evaluated. The morbidity of patients was high, and most patients had at least one of the following diagnoses: pulmonary (62%), cardiovascular (61%), and/or neurological disease (55%). Of the patients 32 (31%) were transferred to the PC ward, among whom weakness (94%), fatigue (77%), anxiety (55%), pain (53%), and dyspnea (48%) were the most frequently noted symptoms. Of the transferred patients 5 (16%) could be discharged to home, nursing home, hospice or other. In total, 35 (34%) of all patients who were seen by palliative care specialists on ICUs in 2019 could be discharged alive. The most frequent reasons for nonadmission were lack of capacity of the PC ward (33%), dying while being on the waiting list (20%), and refusal by the patient (20%). Of the patients, 7 (26%) died within 48 h after they had been transferred to the PC ward. Performed consultation services "symptom control" (χ = 10.17; p < 0.05) and "counselling" (χ = 12.82; p < 0.001), which were requested by the intensive care physicians, showed a significant linkage with the respective intervention performed by the palliative care team. On the other hand, no statistically significant difference was found for requested and performed "transfer" of patients from ICUs to PC ward. Comparing the transferred versus non-transferred patient population, a significantly more frequent transfer of patients with malignant tumors (p = 0.00) was observed.
The need for palliative care support in the ICUs exceeded the admission capacity of the PC ward. Future studies should further examine palliative care models in intensive care medicine.
患者从重症监护病房（ICU）转入姑息治疗（PC）病房通常意味着包括确立姑息治疗理念在内的诸多变化。调整治疗目标对医护人员、患者及其亲属而言可能具有挑战性；然而，关于这些过渡轨迹的描述却很罕见。
这项回顾性研究的目的是通过描述轨迹和干预措施来刻画ICU向PC咨询团队提出的咨询请求以及患者的特征。
对2019年在亚琛工业大学医院接受重症监护且被请求进行PC咨询的所有患者进行回顾性分析。将从ICU转入PC病房的患者群体与未转入的群体进行比较。在每种情况下，对初次咨询评估以下因素：问题、警觉性、从咨询请求到咨询执行的时间长度以及问题的主要关注点。问题关注点分为“症状控制”、“咨询”和“转科”（勾选选项）。此外，还有一个自由文本字段用于进一步记录。通过查阅电子健康记录来补充对诊断的探究。
共评估了102份从ICU向PC病房提出的咨询请求。患者的发病率很高，大多数患者至少有一种以下诊断：肺部疾病（62%）、心血管疾病（61%）和/或神经系统疾病（55%）。32名（31%）患者被转入PC病房，其中虚弱（94%）、疲劳（77%）、焦虑（55%）、疼痛（53%）和呼吸困难（48%）是最常被提及的症状。在转入的患者中，5名（16%）可以出院回家、养老院、临终关怀机构或其他地方。2019年在ICU接受姑息治疗专家诊治的所有患者中，总计35名（34%）可以存活出院。未被收治的最常见原因是PC病房床位不足（33%）、在等待名单上死亡（20%）和患者拒绝（20%）。7名（26%）患者在转入PC病房后48小时内死亡。重症监护医生请求的“症状控制”（χ = 10.17；p < 0.05）和“咨询”（χ = 12.82；p < 0.001）与姑息治疗团队执行的相应干预措施之间存在显著关联。另一方面，对于从ICU向PC病房请求并执行的患者“转科”，未发现统计学上的显著差异。比较转入与未转入的患者群体，观察到患有恶性肿瘤的患者转科频率显著更高（p = 0.00）。
ICU对姑息治疗支持的需求超过了PC病房的收治能力。未来的研究应进一步考察重症监护医学中的姑息治疗模式。
