在ICU入院后48小时内死亡的患者的生命维持治疗限制:法国,多中心,观察性,探索性研究
Aurélie Nouvel1, Pierre Leprovost2, Charlotte Larrat3
1Medical Intensive Care Unit, Nantes University Hospital, Nantes, France.
Critical care explorations
|August 6, 2025
概括
大多数早期的ICU死亡都涉及决定限制维持生命治疗 (LST-L). 患者的愿望很少被考虑,这凸显了在关键情况下需要改善沟通和以患者为中心的护理.
科学领域:
- 关键护理医学 关键护理医学
- 医学伦理 医学伦理
- 患者的治疗结果.
背景情况:
- 在重症监护室 (ICU) 入院后的早期死亡引发了关于重症监护对脆弱患者的适用性的问题.
- 在这些情况下,决定限制维持生命治疗 (LST-L) 是常见的,但总体比例尚不清楚.
研究的目的:
- 确定在ICU入院后48小时内死亡的患者中,LST-L决定的比例.
- 确定与LST-L相关的因素,并探索医疗保健工作人员的看法.
主要方法:
- 一个回顾性,观察性,多中心研究,涉及法国12个ICU.
- 在2022-2023年期间,收集了在ICU入院后48小时内死亡的患者的数据.
- 对于LST-L的决定,由正在治疗的重症监护医生自行决定.
主要成果:
- 在48小时内死亡的100名患者中,62人 (62%) 有LST-L决定.
- 患有LST-L的患者年龄较大,并具有较高的并发症评分,并且接受了不那么侵入性的治疗.
- 男性患者的LST-L决定的可能性较小 (OR 0.35). 患者的愿望很少被考虑,决定往往是在值班时间做出的.
结论:
- 大多数早期的ICU死亡都是在LST-L决定之前.
- 需要更好地纳入患者的愿望,并加强医生和护士之间的沟通.
- 这些发现强调了确保适当护理的重要性,即使患者的偏好是未知的.
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