小児重症病棟における医療介入の制限と撤回

M Levetown¹, M M Pollack, T T Cuerdon

¹Department of Critical Care Medicine, Children's National Medical Center, Washington, DC 20010.

JAMA

|October 26, 1994

まとめ

再蘇生しない (DNR) 命令を含む医療介入の制限は,小児重症病棟 (PICU) で一般的であった. 生活の質ではなく,差し迫った死が,これらの人生を変える決断の主な理由でした.

科学分野:

小児重症病棟医療幼児重症病棟医療
医療倫理医療倫理について
保健医療政策について

背景:

医療介入の制限は,小児重症病棟 (PICU) での重要な決定です.
これらの制限のパターンと正当性を理解することは,終末期ケアを改善するために不可欠です.
介入制限の3つのレベルは一般的に考慮されています:蘇生させない (DNR),DNRを超える追加の制限,および介護の撤回.

研究の目的:

PICUにおける3つの異なるレベルの医療介入制限の利用と実施を調査する.
これらの制限の対象となる小児患者の特徴を分析する.
医療介入の制限に関連する主な正当化と慣行を特定する.

主な方法:

様々な環境でランダムに選択された16のPICUを対象とした研究.
5415人の入院患者のうち,介入制限を受けた119人の小児患者の分析.
データ収集は,患者のプロファイル,慢性疾患,制限の理由,および実施の詳細に焦点を当てました.

主要な成果:

制限は,調査されたすべてのPICUで実施され,死亡した患者の79%に影響を与えました.
急性疾患,特に中枢神経系および呼吸器系の問題が,制限の主な動機 (61%) であった.
DNR (35%),追加の制限 (9%) および離脱 (2%) の制限レベルが増加すると,生存率は著しく低下しました.

結論:

医療介入の制限は,PICUで標準的な慣行です.
慢性疾患は存在していたが,急性疾患は主に制限決定を早めた.
制限の主な正当化は,生活の質や過度の負担に対する懸念ではなく,差し迫った死でした.

キーワード:

死と安楽死について経験的アプローチである.

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