生命支持疗法的撤离/停止:重症监护病房中的治疗效果限制。
Withdrawal/Withholding of Life-Sustaining Therapies: Limitation of Therapeutic Effort in the Intensive Care Unit.
机构信息
Department of Anesthesiology, Intensive Care and Pain Medicine, Hospital Universitario de Gran Canaria Doctor Negrín, 35010 Las Palmas de Gran Canaria, Spain.
Department of Medical and Surgical Sciences, Universidad de Las Palmas de Gran Canaria, 35001 Las Palmas de Gran Canaria, Spain.
出版信息
Medicina (Kaunas). 2024 Sep 6;60(9):1461. doi: 10.3390/medicina60091461.
: The change in critically ill patients makes limitation of therapeutic effort (LTE) a widespread practice when therapeutic goals cannot be achieved. We aimed to describe the application of LTE in a post-surgical Intensive Care Unit (ICU), analyze the measures used, the characteristics of the patients, and their evolution. Retrospective observational study, including all patients to whom LTE was applied in a postsurgical ICU between January 2021 and December 2022. The LTE defined were brain death, withdrawal of measures, and withholding. Withholding limitations included orders for no cardiopulmonary resuscitation, no orotracheal intubation, no reintubation, no tracheostomy, no renal replacement therapies, and no vasoactive support. Patient and ICU admission data were related to the applied LTE. : Of the 2056 admitted, LTE protocols were applied to 106 patients. The prevalence of LTE in the ICU was 5.1%. Data were analyzed in 80 patients. A total of 91.2% of patients had been admitted in an emergency situation, and 56.2% had been admitted after surgery. The most widespread limitation was treatment withholding (83.8%) compared to withdrawal (13.8%). No differences were found regarding who made the decision and the type of limitation employed. However, patients with the limitation of no intubation had a longer stay ( = 0.025). Additionally, the order of not starting or increasing vasopressor support resulted in a longer hospital stay ( = 0.007) and a significantly longer stay until death ( = 0.044). : LTE is a frequent measure in critically ill patient management and is less common in the postoperative setting. The most widespread measure was withholding, with the do-not-resuscitate order being the most common. The decision was made mainly by the medical team and the family, respecting the wishes of the patients. A joint patient-centered approach should be made in these decisions to avoid futile treatment and ensure end-of-life comfort.
: 危重病患者的病情变化使得限制治疗努力(LTE)成为当治疗目标无法实现时的广泛做法。我们旨在描述 LTE 在术后重症监护病房(ICU)中的应用,分析所采用的措施、患者的特征及其演变。 这是一项回顾性观察研究,纳入了 2021 年 1 月至 2022 年 12 月期间在术后 ICU 中应用 LTE 的所有患者。所定义的 LTE 包括脑死亡、停止治疗和停止维持。维持限制包括不进行心肺复苏、不进行气管插管、不重新插管、不进行气管切开、不进行肾脏替代治疗和不进行血管活性支持的医嘱。患者和 ICU 入院数据与应用的 LTE 相关。 : 在 2056 名入院患者中,有 106 名患者应用了 LTE 方案。ICU 中 LTE 的患病率为 5.1%。对 80 名患者进行了数据分析。总共 91.2%的患者是紧急入院,56.2%的患者是手术后入院。最广泛的限制是治疗停止(83.8%),而停止治疗(13.8%)。在做出决策和采用限制类型方面没有发现差异。然而,未进行插管限制的患者住院时间更长( = 0.025)。此外,不开始或增加血管加压支持的医嘱会导致住院时间延长( = 0.007),并且直到死亡的时间间隔明显延长( = 0.044)。 : LTE 是危重病患者管理中的常见措施,在术后情况下较少见。最广泛的措施是停止治疗,其中不复苏医嘱最常见。决策主要由医疗团队和家属做出,尊重患者的意愿。在这些决策中应采取以患者为中心的联合方法,以避免无效治疗并确保临终舒适。