停止生命支持:生命结束时的重症监护
Thomas J Prendergast1, Kathleen A Puntillo
1Departments of Medicine and Anesthesiology, Dartmouth-Hitchcock Medical Center, Section of Pulmonary and Critical Care Medicine (3D), 1 Medical Center Dr, Lebanon, NH 03756, USA. thomas.j.prendergast@hitchcock.org
对于重症患者来说,决定维持生命的治疗是具有挑战性的. 开放的沟通和与家人共享的决策对于应对这些困难的终身护理选择至关重要.
科学领域:
- 关键护理医学 关键护理医学
- 生物伦理学生物伦理学
- 抚慰性护理是一项非常重要的护理.
背景情况:
- 临界护理支持患有危及生命的疾病的患者,但有些人因恢复能力下降而滞留.
- 关于维持生命治疗的决定是复杂的,特别是当患者无法参与时.
- 在这些决定中的分歧可能会对患者的护理和家庭的福祉产生负面影响.
研究的目的:
- 探索管理危急病患者和不确定的预后的挑战.
- 检查沟通和决策在关键环境中的终身护理中的作用.
- 在这些困难的过渡时期确定缓解冲突和支持家庭的策略.
主要方法:
- 临床情景在重症监护中的定性分析.
- 对维持生命治疗决策中的伦理考虑进行审查.
- 探索医疗团队和家庭之间的沟通策略.
主要成果:
- 患者往往无法参与关于维持生命治疗的决策.
- 家庭代理决策是情感上的压力,容易产生分歧.
- 有效的沟通,症状控制和心理社会支持可以减轻决策压力.
结论:
- 在重症监护中,与家人共享决策至关重要.
- 及时的信息和强有力的支持促进了更好的终身护理选择.
- 重症监护可能涉及从维持生命的干预转向以舒适为中心的护理.
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