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Respiratory support withdrawal in intensive care units: families, physicians and nurses views on two hypothetical clinical scenarios

机译：重症监护病房撤回呼吸支持：家庭，医生和护士对两种假想临床情景的看法

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IntroductionEvidence suggests that dying patients' physical and emotional suffering is inadequately treated in intensive care units. Although there are recommendations regarding decisions to forgo life-sustaining therapy, deciding on withdrawal of life support is difficult, and it is also difficult to decide who should participate in this decision.MethodsWe distributed a self-administered questionnaire in 13 adult intensive care units (ICUs) assessing the attitudes of physicians and nurses regarding end-of-life decisions. Family members from a medical-surgical ICU in a tertiary cancer hospital were also invited to participate. Questions were related to two hypothetical clinical scenarios, one with a competent patient and the other with an incompetent patient, asking whether the ventilator treatment should be withdrawn and about who should make this decision.ResultsPhysicians (155) and nurses (204) of 12 ICUs agreed to take part in this study, along with 300 family members. The vast majority of families (78.6%), physicians (74.8%) and nurses (75%) want to discuss end-of-life decisions with competent patients. Most of the physicians and nurses desire family involvement in end-of-life decisions. Physicians are more likely to propose withdrawal of the ventilator with competent patients than with incompetent patients (74.8% × 60.7%, P = 0.028). When the patient was incompetent, physicians (34.8%) were significantly less prone than nurses (23.0%) and families (14.7%) to propose decisions regarding withdrawal of the ventilator support (P < 0.001).ConclusionsPhysicians, nurses and families recommended limiting life-support therapy with terminally ill patients and favored family participation. In decisions concerning an incompetent patient, physicians were more likely to maintain the therapy.
机译：引言有证据表明，重症监护病房未充分治疗垂死的患者的身体和情感痛苦。尽管有关于放弃维持生命治疗的决定的建议，但是决定退出生命支持仍然很困难，而且也很难决定谁应该参加这项决定。 ICU）评估医生和护士对临终决定的态度。来自三级癌症医院的外科ICU的家庭成员也应邀参加。问题与两种假设的临床情况有关，一种情况是一名合格的患者，另一种情况是一名无能的患者，询问是否应撤消呼吸机治疗以及由谁来做出此决定。结果由12个ICU组成的医师（155）和护士（204）同意与300位家庭成员一起参加这项研究。绝大多数家庭（78.6％），医生（74.8％）和护士（75％）希望与合格患者讨论临终决定。大多数医生和护士都希望家人参与临终决策。与有能力的患者相比，有能力的患者与内科医师相比更建议撤出呼吸机（74.8％×60.7％，P = 0.028）。当患者不称职时，医生（34.8％）较护士（23.0％）和家属（14.7％）倾向于建议撤消呼吸机支持的决定（P <0.001）。结论医生，护士和家属建议限制生命-支持对绝症患者的治疗并支持家庭参与。在有关无能患者的决定中，医师更有可能维持治疗。

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