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重症监护病房的终末关怀和生命支持治疗的 withholding/withdrawal 伦理

End-of-life Care in the Intensive Care Unit and Ethics of Withholding/Withdrawal of Life-sustaining Treatments.

机构信息

Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anesthesia Analgesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Via del vespro 129, Palermo 90127, Italy.

Department of Precision Medicine in Medical, Surgical and Critical Care Area (Me.Pre.C.C.), University of Palermo, Palermo, Italy; Department of Anesthesia Analgesia Intensive Care and Emergency, University Hospital Policlinico 'Paolo Giaccone', Via del vespro 129, Palermo 90127, Italy.

出版信息

Anesthesiol Clin. 2024 Sep;42(3):407-419. doi: 10.1016/j.anclin.2024.02.008. Epub 2024 Mar 15.

Abstract

The medical progress has produced improvements in critically ill patients' survival to early phases of life-threatening diseases, thus producing long intensive care stays and persisting disability, with uncertain long-term survival rates and quality of life. Thus, compassionate end-of-life care and the provision of palliative care, even overlapping with the most aggressive of curative intensive care unit (ICU) care has become crucial. Moreover, withdrawal or withholding of life-sustaining treatment may be adopted, allowing unavoidable deaths to occur, without prolonging agony or ICU stay. Our aim was to summarize the key element of end-of-life care in the ICU and the ethics of withholding/withdrawal life-sustaining treatments.

摘要

医学的进步使危重病患者的生存率得到了提高,能够存活到危及生命的疾病的早期阶段,但这也导致了患者需要长时间接受重症监护治疗,并留下持久的残疾,长期生存率和生活质量不确定。因此,临终关怀和姑息治疗的提供,甚至与最积极的治愈性重症监护病房(ICU)治疗重叠,已变得至关重要。此外,可能会采取停止或撤销生命维持治疗的措施,从而允许不可避免的死亡发生,而不会延长痛苦或 ICU 住院时间。我们的目的是总结 ICU 临终关怀的关键要素以及拒绝/撤销生命维持治疗的伦理学问题。

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