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在儿科重症监护中限制和取消医疗干预
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
概括
医疗干预限制,包括不复苏 (DNR) 命令,在儿科重症监护室 (PICU) 中很常见. 迫在眉的死亡,而不是生活质量,是这些改变生活的决定的主要原因.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 医学伦理 医学伦理
- 医疗保健政策 医疗保健政策
背景情况:
- 对医疗干预的限制是儿科重症监护室 (PICU) 中的关键决定.
- 了解这些限制的模式和理由对于改善终身护理至关重要.
- 通常考虑三种干预限制级别:不要复苏 (DNR),超过DNR的额外限制,以及护理的撤回.
研究的目的:
- 调查PICU中三种不同级别的医疗干预限制的利用和实施情况.
- 分析受这些限制的儿科患者的特征.
- 确定与限制医疗干预相关的主要理由和做法.
主要方法:
- 一项涉及16个随机选择的PICU在不同环境中的研究.
- 对119名接受干预限制的儿科患者的分析,共5415例入院.
- 数据收集的重点是患者个人资料,慢性疾病,限制的原因和实施细节.
主要成果:
- 在所有接受调查的PICU中实施了限制,影响了79%的患者死亡.
- 急性疾病,特别是中枢神经系统和呼吸系统问题,是限制的主要驱动因素 (61%).
- 随着限制水平的增加,生存率显著下降:DNR (35%),额外的限制 (9%) 和戒断 (2%).
结论:
- 医疗干预限制是PICU的标准做法.
- 虽然存在慢性疾病,但急性疾病主要导致限制决定.
- 限制的主要理由是即将死亡,而不是对生活质量或过度负担的担忧.
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