老年人和非常老年患者之间限制治疗和停止机械通风的指令的差异:一项跨国观察性研究的副研究
Karen E A Burns1,2,3,4, Deborah J Cook5,6, Keying Xu7,8
1Interdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. karen.burns@unityhealth.to.
Intensive care medicine
|September 22, 2023
概括
非常老的ICU患者收到更多的拒绝治疗的命令,并且在医院死亡率更高,但ICU的结果和侵入性机械通风停止与老年患者相似. 观察到护理实践的区域差异.
科学领域:
- 关键护理医学 关键护理医学
- 老年医学 老年医学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 限制治疗和停止侵入性机械通风 (IMV) 是重症监护病房 (ICU) 中的关键决定.
- 了解这些决策中的年龄相关差异对于优化对老年人群的护理至关重要.
研究的目的:
- 为了比较老年人 (65-80岁) 和非常老年人 (>80岁) ICU 患者之间的治疗限制和 IMV 停药指令.
- 确定影响这些决定的因素及其与患者结果的关联.
主要方法:
- 在全球6个地区的142个ICU进行前性研究.
- 描述新的书面命令的治疗限制和IMV停止策略.
- 分析了最初失败的自发呼吸试验 (SBT) 和结果之间的关联.
主要成果:
- 与老年患者相比,非常老年患者在ICU入院后有更多的扣留命令 (例如,CPR,透析).
- 在不同年龄组之间观察到类似的IMV停药策略 (输出管,气管切除术,SBT) 率.
- 非常老年患者的ICU结局类似,但医院死亡率更高;直接气管切除术和失败的SBT与更糟糕的结局相关.
结论:
- 非常老年患者在ICU入院后收到更多的扣留命令,并且在医院死亡率较高,尽管ICU结果和IMV停药率相似.
- 对于重症老年患者的扣留和撤回做法存在显著的区域差异.
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