A national survey of end-of-life care for critically ill patients

被引:462
作者
Prendergast, TJ [1 ]
Claessens, MT
Luce, JM
机构
[1] Vet Adm Med Ctr, Pulm Sect 111, Dept Med, White River Junction, VT 05009 USA
[2] Dartmouth Med Sch, Dept Med, Lebanon, NH USA
[3] Univ Ottawa, Inst Palliat Care, Ottawa, ON, Canada
[4] Univ Calif San Francisco, Dept Med, San Francisco, CA USA
[5] Univ Calif San Francisco, Inst Hlth Policy Studies, San Francisco, CA 94143 USA
[6] San Francisco Gen Hosp, San Francisco, CA 94110 USA
关键词
D O I
10.1164/ajrccm.158.4.9801108
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
In some intensive care units (ICUs), fewer patients who die now undergo attempts at cardiopulmonary resuscitation (CPR), and many more have life support actively withdrawn prior to death than did a decade ago. To determine the frequency of withdrawal of life support, we contacted every American postgraduate training program with significant clinical exposure to critical care medicine, asking them prospectively to classify patients who died into one of five mutually exclusive categories. We received data from 131 ICUs at 110 institutions in 38 states. There were 6,303 deaths, of which 393 patients were brain dead. Of the remaining 5,910 patients who died, 1,544 (23%) received full ICU care including failed cardiopulmonary resuscitation (CPR); 1,430 (22%) received full ICU care without CPR; 797 (10%) had life support withheld; and 2,139 (38%) had life support withdrawn. There was wide variation in practice among ICUs, with ranges of 4 to 79%, 0 to 83%, 0 to 67%, and 0 to 79% in these four categories, respectively. Variation was not related to ICU type, hospital type, number of admissions, or ICU mortality. We conclude that limitation of life support prior to death is the predominant practice in American ICUs associated with critical care training programs. There is wide variation in end-of-life care, and efforts are needed to understand practice patterns and to establish standards of care for patients dying in ICUs.
引用
收藏
页码:1163 / 1167
页数:5
相关论文
共 12 条
[1]  
[Anonymous], DARTM ATL HLTH CAR 1
[2]   Withdrawing intensive life-sustaining treatment - Recommendations for compassionate clinical management [J].
Brody, H ;
Campbell, ML ;
FaberLangendoen, K ;
Ogle, KS .
NEW ENGLAND JOURNAL OF MEDICINE, 1997, 336 (09) :652-657
[3]   A prospective study of the impact of patient preferences on life-sustaining treatment and hospital cost [J].
Danis, M ;
Mutran, E ;
Garrett, JM ;
Stearns, SC ;
Slifkin, RT ;
Hanson, L ;
Williams, JF ;
Churchhill, LR .
CRITICAL CARE MEDICINE, 1996, 24 (11) :1811-1817
[4]   PROCESS OF FORGOING LIFE-SUSTAINING TREATMENT IN A UNIVERSITY HOSPITAL - AN EMPIRICAL-STUDY [J].
FABERLANGENDOEN, K ;
BARTELS, DM .
CRITICAL CARE MEDICINE, 1992, 20 (05) :570-577
[5]  
GINDES D, 1989, AM J LAW MED, V15, P301
[6]   A letter from a patient's daughter [J].
Hansot, E .
ANNALS OF INTERNAL MEDICINE, 1996, 125 (02) :149-151
[7]   A CONTROLLED TRIAL TO IMPROVE CARE FOR SERIOUSLY ILL HOSPITALIZED-PATIENTS - THE STUDY TO UNDERSTAND PROGNOSES AND PREFERENCES FOR OUTCOMES AND RISKS OF TREATMENTS (SUPPORT) [J].
KNAUS, WA ;
CONNORS, AF ;
DAWSON, NV ;
DESBIENS, NA ;
FULKERSON, WJ ;
GOLDMAN, L ;
LYNN, J ;
OYE, RK ;
BERGNER, M ;
DAMIANO, A ;
HAKIM, R ;
MURPHY, DJ ;
TENO, J ;
VIRNIG, B ;
WAGNER, DP ;
WU, AW ;
YASUI, Y ;
ROBINSON, DK ;
KRELING, B ;
DULAC, J ;
BAKER, R ;
HOLAYEL, S ;
MEEKS, T ;
MUSTAFA, M ;
VEGARRA, J ;
ALZOLA, C ;
HARRELL, FE ;
COOK, EF ;
HAMEL, MB ;
PETERSON, L ;
PHILLIPS, RS ;
TSEVAT, J ;
FORROW, L ;
LESKY, L ;
DAVIS, R ;
KRESSIN, N ;
SOLZAN, J ;
PUOPOLO, AL ;
BARRETT, LQ ;
BUCKO, N ;
BROWN, D ;
BURNS, M ;
FOSKETT, C ;
HOZID, A ;
KEOHANE, C ;
MARTINEZ, C ;
MCWEENEY, D ;
MELIA, D ;
OTTO, S ;
SHEEHAN, K .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1995, 274 (20) :1591-1598
[8]   CHANGING PATTERNS OF TERMINAL CARE MANAGEMENT IN AN INTENSIVE-CARE UNIT [J].
KOCH, KA ;
RODEFFER, HD ;
WEARS, RL .
CRITICAL CARE MEDICINE, 1994, 22 (02) :233-243
[9]  
Prendergast T J, 1997, New Horiz, V5, P62
[10]   Increasing incidence of withholding and withdrawal of life support from the critically ill [J].
Prendergast, TJ ;
Luce, JM .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 1997, 155 (01) :15-20