在重症监护室的预先指示:一项为期八年的前沿队列研究
Sira M Baumann1, Simon A Amacher2, Yasmin Erne3
1Intensive Care Unit, Department of Acute Medicine, University Hospital Basel, Basel, Switzerland.
Journal of critical care
|September 18, 2024
概括
预先指示在ICU中不常见,并且往往不清楚. 违规行为可能导致更糟糕的结果和降低的生存率,强调需要更好地执行患者的愿望.
科学领域:
- 关键护理医学 关键护理医学
- 医学伦理 医学伦理
- 医疗保健服务研究 医疗服务研究
背景情况:
- 预先指示 (ADs) 对于重症监护中的患者自主性至关重要.
- 了解它们在重症监护室 (ICU) 的使用和坚持是改善终身护理的关键.
研究的目的:
- 确定ICU中ADS的频率,内容质量和临床实施.
- 评估AD违规行为对患者结果的影响.
主要方法:
- 追溯队列研究,涉及在瑞士第三级ICU治疗≥48小时的患者.
- 对AD流行,内容 (模板使用,清晰度) 和违规率的分析.
- 主要终点:AD违规;次要终点:流行率和临床转化.
主要成果:
- 在5851名ICU患者中,只有2.7%的患者记录了ADs.
- 19%的ADs有主观的措辞,12%是矛盾的,尽管92%的模板使用.
- 9%的ADs被违反,与更糟糕的住院结果 (p=0.012) 和更低的生存率 (p=0.04) 相联系.
结论:
- 辅助医疗的使用量不足,在ICU中往往缺乏清晰度.
- 违反ADs会对患者的结果和长期存活率产生负面影响.
- 改善AD文档和坚持是尊重重症监护中的患者自主权的关键.
相关概念视频
Standards of Care II
636
Nurses bear specific legal responsibilities under several federal statutes, including:
636
Acute Respiratory Failure-II
179
Type I Respiratory Failure, or hypoxemic respiratory failure, occurs when the partial pressure of oxygen (PaO2) in arterial blood falls below 60 mmHg while breathing room air without a corresponding increase in arterial carbon dioxide levels (PaCO2). This condition highlights a significant impairment in the lungs' capacity to oxygenate the blood.
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
179
Standards of Care I
670
Federal statutes profoundly impact nursing practice, providing critical guidelines to ensure patient care is equitable, accessible, and of the highest quality. The following laws address distinct aspects of healthcare provision and patient rights:
670
Acute Respiratory Failure-V
124
The treatment for acute respiratory failure varies based on factors like the underlying cause, overall health, and severity. A collaborative healthcare team is essential for early detection, often through arterial blood gas analysis. Identifying the cause is the primary goal, with treatment strategies adjusted for ventilation/perfusion (V/Q) mismatch, shunting, or diffusion impairment.
Ensure that patients are monitored continuously for their response to therapy, including changes in...
Ensure that patients are monitored continuously for their response to therapy, including changes in...
124
Acute Respiratory Failure-III
162
Hypercapnic respiratory failure, also known as Type 2 or ventilatory respiratory failure, is a severe condition characterized by the body's inability to effectively remove carbon dioxide (CO2) from the bloodstream. It leads to an arterial CO2 pressure (PaCO2) exceeding 45 mmHg and a blood pH above 7.35. This situation indicates that the body's ventilatory demand, or the ventilation needed to maintain normal PaCO2 levels, surpasses its supply or the maximum gas flow achievable without...
162
Acute Respiratory Failure-I
177
Acute respiratory failure is a condition characterized by the inability of the lungs to perform their primary function: gas exchange. This failure leads to insufficient oxygen levels (hypoxemia) in the blood, elevated carbon dioxide levels (hypercapnia), or both, causing critical impairment in organ function.
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
177


