{"id":17855,"date":"2019-10-11T05:33:17","date_gmt":"2019-10-10T21:33:17","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=17855"},"modified":"2019-10-29T22:50:33","modified_gmt":"2019-10-29T14:50:33","slug":"jama%e5%9c%a8%e7%ba%bf%e5%8f%91%e8%a1%a8%ef%bc%9a1996%e5%b9%b4%e8%87%b32016%e5%b9%b4%e6%ac%a7%e6%b4%b2icu%e7%94%9f%e5%91%bd%e7%bb%88%e6%9c%ab%e6%9c%9f%e5%ae%9e%e8%b7%b5%e7%9a%84%e6%94%b9%e5%8f%98","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=17855","title":{"rendered":"[JAMA\u5728\u7ebf\u53d1\u8868]\uff1a1996\u5e74\u81f32016\u5e74\u6b27\u6d32ICU\u4e34\u7ec8\u6cbb\u7597\u5b9e\u8df5\u7684\u6539\u53d8"},"content":{"rendered":"\n

Original Investigation Caring for the Critically Ill PatientOctober 2, 2019<\/p>\n\n\n\n

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016<\/h1>\n\n\n\n

Charles L. Sprung, Bara Ricou, Christiane S. Hartog, et al<\/h3>\n\n\n\n

JAMA. <\/em>Published online October 2, 2019. doi:10.1001\/jama.2019.14608<\/h3>\n\n\n\n

Importance<\/strong> \u80cc\u666f<\/h3>\n\n\n\n

End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.<\/p>\n\n\n\n

\u751f\u547d\u7ec8\u672b\u671f\u51b3\u7b56\u5728\u5168\u7403ICU\u5185\u6bcf\u5929\u90fd\u5728\u53d1\u751f\uff0c\u5176\u884c\u4e3a\u53ef\u80fd\u968f\u65f6\u95f4\u800c\u6539\u53d8\u3002<\/p>\n\n\n\n

Objective<\/strong> \u76ee\u7684<\/h3>\n\n\n\n

To determine the changes in end-of-life practices in European ICUs after 16 years.<\/p>\n\n\n\n

\u786e\u5b9a16\u5e74\u540e\u6b27\u6d32ICU\u4e2d\u4e34\u7ec8\u6cbb\u7597\u5b9e\u8df5\u7684\u6539\u53d8<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong> \u8bd5\u9a8c\u8bbe\u8ba1\uff0c\u573a\u666f\u53ca\u7814\u7a76\u4eba\u7fa4<\/h3>\n\n\n\n

Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision.<\/p>\n\n\n\n

Ethicus-2\u662f\u5bf9\u4e8eEthicus-1\u7814\u7a76(1999-2000)\u4e2d\u7eb3\u5165\u768422\u4e2a\u6b27\u6d32ICU\u8fdb\u884c\u7684\u4e00\u9879\u524d\u77bb\u89c2\u5bdf\u6027\u7814\u7a76\u30022015\u5e749\u6708\u81f32016\u5e7410\u6708\u95f4\uff0c\u6bcf\u4e2aICU\u81ea\u884c\u9009\u62e9\u8fde\u7eed6\u4e2a\u6708\u4f5c\u4e3a\u7814\u7a76\u671f\u9650\uff0c\u671f\u95f4\u8fde\u7eed\u6b7b\u4ea1\u6216\u91c7\u53d6\u4efb\u4f55\u9650\u5236\u751f\u547d\u652f\u6301\u6cbb\u7597\u63aa\u65bd\u7684\u60a3\u8005\u5165\u9009\u3002\u60a3\u8005\u968f\u8bbf\u81f3\u6b7b\u4ea1\u6216\u9996\u6b21\u4f5c\u51fa\u9650\u5236\u6cbb\u7597\u51b3\u5b9a\u540e2\u4e2a\u6708\u3002<\/p>\n\n\n\n

Exposures<\/strong> \u66b4\u9732\u56e0\u7d20<\/h3>\n\n\n\n

Comparison between the 1999-2000 cohort vs 2015-2016 cohort.<\/p>\n\n\n\n

1999-2000\u961f\u5217\u4e0e2015-2016\u961f\u5217\u7684\u6bd4\u8f83<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong> \u4e3b\u8981\u9884\u540e\u6307\u6807<\/h3>\n\n\n\n

End-of-life outcomes were classified into 5 mutually exclusive categories (withholding of life-prolonging therapy, withdrawing of life-prolonging therapy, active shortening of the dying process, failed cardiopulmonary resuscitation [CPR], brain death). The primary outcome was whether patients received any treatment limitations (withholding or withdrawing of life-prolonging therapy or shortening of the dying process). Outcomes were determined by senior intensivists.<\/p>\n\n\n\n

\u4e34\u7ec8\u9884\u540e\u5206\u4e3a\u76f8\u4e92\u6392\u65a5\u76845\u79cd\u60c5\u51b5\uff08\u9650\u5236\u751f\u547d\u652f\u6301\u6cbb\u7597\u5f3a\u5ea6\uff0c\u64a4\u9664\u751f\u547d\u652f\u6301\u6cbb\u7597\uff0c\u4e3b\u52a8\u7f29\u77ed\u6b7b\u4ea1\u8fc7\u7a0b\uff0c\u5fc3\u80ba\u590d\u82cf[CPR]\u5931\u8d25\uff0c\u8111\u6b7b\u4ea1\uff09\u3002\u4e3b\u8981\u9884\u540e\u6307\u6807\u4e3a\u60a3\u8005\u662f\u5426\u63a5\u53d7\u4efb\u4f55\u9650\u5236\u6cbb\u7597\u7684\u63aa\u65bd\uff08\u9650\u5236\u6cbb\u7597\u5f3a\u5ea6\u6216\u64a4\u9664\u6cbb\u7597\u6216\u7f29\u77ed\u6b7b\u4ea1\u8fc7\u7a0b\uff09\u3002\u7531\u9ad8\u5e74ICU\u533b\u751f\u786e\u5b9a\u9884\u540e\u3002<\/p>\n\n\n\n

Results<\/strong> \u7ed3\u679c<\/h3>\n\n\n\n

Of 13\u202f625 patients admitted to participating ICUs during the 2015-2016 study period, 1785 (13.1%) died or had limitations of life-prolonging therapies and were included in the study. Compared with the patients included in the 1999-2000 cohort (n\u2009=\u20092807), the patients in 2015-2016 cohort were significantly older (median age, 70 years [interquartile range {IQR}, 59-79] vs 67 years [IQR, 54-75]; P<\/em>\u2009<\u2009.001) and the proportion of female patients was similar (39.6% vs 38.7%; P<\/em>\u2009=\u2009.58). Significantly more treatment limitations occurred in the 2015-2016 cohort compared with the 1999-2000 cohort (1601 [89.7%] vs 1918 [68.3%]; difference, 21.4% [95% CI, 19.2% to 23.6%]; P<\/em>\u2009<\u2009.001), with more withholding of life-prolonging therapy (892 [50.0%] vs 1143 [40.7%]; difference, 9.3% [95% CI, 6.4% to 12.3%]; P<\/em>\u2009<\u2009.001), more withdrawing of life-prolonging therapy (692 [38.8%] vs 695 [24.8%]; difference, 14.0% [95% CI, 11.2% to 16.8%]; P<\/em>\u2009<\u2009.001), less failed CPR (110 [6.2%] vs 628 [22.4%]; difference, \u221216.2% [95% CI, \u221218.1% to \u221214.3%]; P<\/em>\u2009<\u2009.001), less brain death (74 [4.1%] vs 261 [9.3%]; difference, \u22125.2% [95% CI, \u22126.6% to \u22123.8%]; P<\/em>\u2009<\u2009.001) and less active shortening of the dying process (17 [1.0%] vs 80 [2.9%]; difference, \u22121.9% [95% CI, \u2212<\/strong>2.7% to \u22121.1%]; P<\/em>\u2009<\u2009.001).<\/p>\n\n\n\n

\u57282015-2016\u7814\u7a76\u671f\u95f4\uff0c\u5171\u670913\u202f625\u540d\u60a3\u8005\u6536\u5165\u53c2\u7814ICU\uff0c\u5176\u4e2d1785\u540d (13.1%) \u60a3\u8005\u6b7b\u4ea1\u6216\u9650\u5236\u751f\u547d\u652f\u6301\u6cbb\u7597\uff0c\u56e0\u800c\u7eb3\u5165\u672c\u7814\u7a76\u3002\u4e0e1999-2000\u961f\u5217\u7eb3\u5165\u60a3\u8005(n\u2009=\u20092807)\u76f8\u6bd4\uff0c2015-2016\u961f\u5217\u60a3\u8005\u5e74\u9f84\u66f4\u5927 (\u4e2d\u4f4d\u5e74\u9f84, 70 \u5c81 [\u56db\u5206\u4f4d\u533a\u95f4 {IQR}, 59-79] vs 67 \u5c81 [IQR, 54-75]; P<\/em>\u2009<\u2009.001)\uff0c\u5973\u6027\u60a3\u8005\u6bd4\u4f8b\u76f8\u4f3c (39.6% vs 38.7%; P<\/em>\u2009=\u2009.58)\u30022015-2016\u961f\u5217\u60a3\u8005\u8f831999-2000\u961f\u5217\u63a5\u53d7\u4e86\u66f4\u591a\u7684\u6cbb\u7597\u9650\u5236 (1601 [89.7%] vs 1918 [68.3%]; \u5dee\u5f02, 21.4% [95% CI, 19.2% to 23.6%]; P<\/em>\u2009<\u2009.001)\uff0c\u66f4\u591a\u9650\u5236\u751f\u547d\u652f\u6301\u6cbb\u7597\u5f3a\u5ea6 (892 [50.0%] vs 1143 [40.7%]; \u5dee\u5f02, 9.3% [95% CI, 6.4% to 12.3%]; P<\/em>\u2009<\u2009.001)\uff0c\u66f4\u591a\u64a4\u51fa\u751f\u547d\u652f\u6301\u6cbb\u7597 (692 [38.8%] vs 695 [24.8%]; \u5dee\u5f02, 14.0% [95% CI, 11.2% to 16.8%]; P<\/em>\u2009<\u2009.001)\uff0cCPR\u5931\u8d25\u66f4\u5c11 (110 [6.2%] vs 628 [22.4%]; \u5dee\u5f02, \u221216.2% [95% CI, \u221218.1% to \u221214.3%]; P<\/em>\u2009<\u2009.001)\uff0c\u8111\u6b7b\u4ea1\u66f4\u5c11 (74 [4.1%] vs 261 [9.3%]; \u5dee\u5f02, \u22125.2% [95% CI, \u22126.6% to \u22123.8%]; P<\/em>\u2009<\u2009.001)\uff0c\u4e3b\u52a8\u7f29\u77ed\u6b7b\u4ea1\u8fc7\u7a0b\u66f4\u5c11 (17 [1.0%] vs 80 [2.9%]; \u5dee\u5f02, \u22121.9% [95% CI, \u2212<\/strong>2.7% to \u22121.1%]; P<\/em>\u2009<\u2009.001)\u3002<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong> \u7ed3\u8bba\u4e0e\u610f\u4e49<\/h3>\n\n\n\n

Among patients who had treatment limitations or died in 22 European ICUs in 2015-2016, compared with data reported from the same ICUs in 1999-2000, limitations in life-prolonging therapies occurred significantly more frequently and death without limitations in life-prolonging therapies occurred significantly less frequently. These findings suggest a shift in end-of-life practices in European ICUs, but the study is limited in that it excluded patients who survived ICU hospitalization without treatment limitations.<\/p>\n\n\n\n

\u6b27\u6d3222\u4e2aICU\u4e2d\u9650\u5236\u6cbb\u7597\u6216\u6b7b\u4ea1\u7684\u60a3\u8005\u4e2d\uff0c\u4e0e1999-2000\u5e74\u76f8\u540cICU\u62a5\u544a\u7684\u6570\u636e\u76f8\u6bd4\uff0c2015-2016\u5e74\u95f4\u9650\u5236\u751f\u547d\u652f\u6301\u6cbb\u7597\u7684\u60c5\u51b5\u66f4\u4e3a\u666e\u904d\uff0c\u800c\u672a\u9650\u5236\u751f\u547d\u652f\u6301\u6cbb\u7597\u7684\u6b7b\u4ea1\u66f4\u5c11\u53d1\u751f\u3002\u8fd9\u4e9b\u7ed3\u679c\u63d0\u793a\uff0c\u6b27\u6d32ICU\u7684\u4e34\u7ec8\u6cbb\u7597\u5b9e\u8df5\u53d1\u751f\u4e86\u6539\u53d8\uff0c\u4f46\u662f\uff0c\u7814\u7a76\u5c40\u9650\u6027\u5728\u4e8e\u6392\u9664\u4e86\u90a3\u4e9b\u6ca1\u6709\u9650\u5236\u6cbb\u7597\u4e14\u5b58\u6d3b\u7684ICU\u60a3\u8005\u3002<\/p>\n\n\n\n

\u8bc4\u8bba[\u4ec5\u4ee3\u8868\u4e2a\u4eba\u89c2\u70b9]<\/h3>\n\n\n\n
  • \u533b\u5b66\u4f26\u7406\u95ee\u9898\u662f\u88ab\u56fd\u5185\u91cd\u75c7\u533b\u5b66\u754c\u5ffd\u89c6\u7684\u9886\u57df<\/li>
  • \u5c3d\u7ba1\u533b\u751f\u7684\u91cd\u8981\u804c\u8d23\u4e4b\u4e00\u662f\u6cbb\u6108\u75be\u75c5\u548c\u60a3\u8005\uff0c\u4f46\u662f\uff0c\u5982\u4f55\u6539\u8fdb\u60a3\u8005\u751f\u6d3b\u8d28\u91cf\uff0c\u5c0a\u91cd\u60a3\u8005\u81ea\u8eab\u610f\u613f\uff0c\u51cf\u5c11\u6b7b\u4ea1\u8fc7\u7a0b\u7684\u75db\u82e6\uff0cICU\u533b\u751f\u65e0\u7591\u4e5f\u662f\u8d23\u65e0\u65c1\u8d37\u7684<\/li>
  • \u5728\u533b\u5b66\u4f26\u7406\u65b9\u9762\uff0c\u56fd\u5185ICU\u62a4\u7406\u540c\u4ec1\u5df2\u7ecf\u8d70\u5728\u4e86\u4e34\u5e8a\u533b\u751f\u524d\u9762\uff0c\u9700\u8981\u6211\u4eec\u53cd\u601d\u548c\u5b66\u4e60<\/li><\/ul>\n\n\n\n

    <\/p>\n","protected":false},"excerpt":{"rendered":"

    Original Investigation Caring for the Critically I […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17855"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=17855"}],"version-history":[{"count":5,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17855\/revisions"}],"predecessor-version":[{"id":17874,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/17855\/revisions\/17874"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=17855"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=17855"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=17855"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}