End-of-life management in intensive care units: a multicentre observational prospective cohort study

被引:4
|
作者
Alliprandini, Marina Z. [1 ]
Ferrandin, Andressa J. [1 ]
Fernandes, Adriana [2 ]
Belim, Mariana C. [1 ]
Jorge, Mariana M. [1 ]
Colombo, Bruno H. B. [1 ]
Yaguchi, Jordana M. [1 ]
Chung, Thais T. [3 ]
Jorge, Amaury C. [3 ]
Duarte, Pericles A. D. [1 ,4 ]
机构
[1] Hosp Univ Oeste Parana, Av Lancredo Neves 3224, BR-85806470 Cascavel, Parana, Brazil
[2] Hosp Sao Lucas FAG, Cascavel, Parana, Brazil
[3] Hosp Univ Oeste Parana, Gen ICU, Cascavel, Parana, Brazil
[4] UOPECCAN, Hosp Canc, Cascavel, Parana, Brazil
关键词
palliative care; intensive care unit; death; patient comfort; PALLIATIVE CARE; ICU PATIENTS; DETERMINANTS; OUTCOMES; QUALITY; DEATH;
D O I
10.5114/ait.2019.91189
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
Backgrounds: The study was conducted to evaluate intensive care unit (ICU) patients that ultimately died but could have met criteria for end-of-life management/palliative care (ELM-PC), and to analyse the application of components of palliative care, either "unperformed procedures" or elements of "futile/unnecessary treatment". Methods: An observational prospective cohort in five ICUs in Southern Brazil. Adult patients who died were evaluated, searching for criteria for ELM-PC. The correct application of nine preselected items by the ICU team was studied. Results: Among 253 admissions, 52 patients died; among these, 38.5% met criteria for ELM-PC. Among ELM-PC candidates (n = 20), the ELM-PC was started later (after day 3) in 60%, and only three patients received adequate palliative care. "Analgesia" and "daily family interviews" were the most correctly applied ELM-PC elements. "Terminal extubation/weaning" was not performed in any of the patients. A reduction in the lifespan from the onset of ELM-PC to death was observed in patients who underwent "correct" interventions - 66.6% died on the first day of ELM-PC. Conclusions: In a patient cohort from a low-medium-income country, one-third of patients who died in the ICU had criteria (indications) for ELM-PC; however, the palliative care was adequately performed for only 15% of patients, with great heterogeneity and delays regarding its initiation.
引用
收藏
页码:348 / 356
页数:9
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