Palliative care interventions in intensive care unit patients,Intensive Care Medicine

当前位置： X-MOL 学术 › Intensive Care Med. › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Palliative care interventions in intensive care unit patients
Intensive Care Medicine ( IF 38.9 ) Pub Date : 2021-10-15 , DOI: 10.1007/s00134-021-06544-6
Victoria Metaxa ₁ , Despina Anagnostou ₂ , Savvas Vlachos ₁ , Nishkantha Arulkumaran ₃ , Sherihane Bensemmane ₄ , Ingeborg van Dusseldorp ₅ , Rebecca A Aslakson _{6,

7} , Judy E Davidson ₈ , Rik T Gerritsen ₉ , Christiane Hartog ₁₀ , J Randall Curtis ₁₁

Affiliation

King's College Hospital, London, SE5 9RS, UK.
School of Medicine, Human Health Sciences, Kyoto University, Kyoto, Japan.
Bloomsbury Institute of Intensive Care Medicine, University College London, London, UK.
Health Services Research, Epidemiology and Public Health, Sciensano, Brussels, Belgium.
van Dusseldorp, Delvaux en Ket, Groningen, The Netherlands.
Division of Primary Care and Population Health, Department of Medicine, Palliative Care Section, Stanford University, Stanford, CA, 94305, USA.
Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University, Stanford, CA, 94305, USA.
Department of Nursing, University of California, San Diego Health Sciences, San Diego, USA.
Centrum voor Intensive Care, Medisch Centrum Leeuwarden, PO Box 888, 8901 BR, Leeuwarden, The Netherlands.
Klinik Bavaria Kreischa, Kreischa, Germany.
Division of Pulmonary, Critical Care and Sleep Medicine, Cambia Palliative Care Center of Excellence at UW Medicine, University of Washington, 325 Ninth Avenue, Box 359762, Seattle, WA, 98104, USA.

Purpose

The integration of palliative care into intensive care units (ICUs) is advocated to mitigate physical and psychological burdens for patients and their families, and to improve end-of-life care. The most efficacious palliative care interventions, the optimal model of their delivery and the most appropriate outcome measures in ICU are not clear.

Methods

We conducted a systematic review of randomised clinical trials and observational studies to evaluate the number and types of palliative care interventions implemented within the ICU setting, to assess their impact on ICU practice and to evaluate differences in palliative care approaches across different countries.

Results

Fifty-eight full articles were identified, including 9 randomised trials and 49 cohort studies; all but 4 were conducted within North America. Interventions were categorised into five themes: communication (14, 24.6%), ethics consultations (5, 8.8%), educational (18, 31.6%), involvement of a palliative care team (28, 49.1%) and advance care planning or goals-of-care discussions (7, 12.3%). Thirty studies (51.7%) proposed an integrative model, whilst 28 (48.3%) reported a consultative one. The most frequently reported outcomes were ICU or hospital length of stay (33/55, 60%), limitation of life-sustaining treatment decisions (22/55, 40%) and mortality (15/55, 27.2%). Quantitative assessment of pooled data was not performed due to heterogeneity in interventions and outcomes between studies.

Conclusion

Beneficial effects on the most common outcomes were associated with strategies to enhance palliative care involvement, either with an integrative or a consultative approach. Few studies reported functional outcomes for ICU patients. Almost all studies were from North America, limiting the generalisability to other healthcare systems.

中文翻译：

重症监护病房患者的姑息治疗干预

目的

提倡将姑息治疗纳入重症监护病房（ICU），以减轻患者及其家人的身心负担，并改善临终关怀。最有效的姑息治疗干预、其交付的最佳模式和 ICU 中最合适的结果措施尚不清楚。

方法

我们对随机临床试验和观察性研究进行了系统评价，以评估在 ICU 环境中实施的姑息治疗干预的数量和类型，评估它们对 ICU 实践的影响，并评估不同国家姑息治疗方法的差异。

结果

确定了 58 篇完整的文章，包括 9 篇随机试验和 49 篇队列研究；除 4 项外，其余均在北美进行。干预措施分为五个主题：沟通（14, 24.6%）、伦理咨询（5, 8.8%）、教育（18, 31.6%）、姑息治疗团队的参与（28, 49.1%）和预先护理计划或目标护理讨论 (7, 12.3%)。30 项研究 (51.7%) 提出了一个综合模型，而 28 项 (48.3%) 报告了一个咨询模型。最常报告的结局是 ICU 或住院时间（33/55, 60%）、维持生命治疗决定的限制（22/55, 40%）和死亡率（15/55, 27.2%）。由于研究之间干预措施和结果的异质性，未对汇总数据进行定量评估。