关键词: 生命终末期, 限制/撤离生命支持治疗, 重症监护, 伦理学, 决策

Abstract:

Objective To investigate the withholding and withdrawing of life supporting treatment in intensive care unit. Methods We undertook a prospective observational study in one Chinese university-hospital intensive care unit(ICU) between Jun 2009 and May 2011. Data were collected from all patients for whom decisions to withhold or withdraw life-supporting treatments were made, the data included age, sex, acute physiology and chronic health evaluation Ⅱ(APACHE Ⅱ), sequential organ failure assessment(SOFA), and previous chronic diseases. All patients were followed up until death or discharge from the ICU, and the length of ICU stay were recorded. Patients for whom such decisions were made were classified by the type of decision: group A was withheld, group B was withdrawn, group C was only DNR during dying. Results Totally 86 patients whose life support was withheld or withdrawn during the ICU duration were enrolled. That was 7.2% of the total admissions in the same period. These patients aged (76.6±12.5) years and 50.0% were male; 68.6% decisions were made by family request; 53.5% patients were covered by medical insurance. Death or discharge occurred 41.0 h after decision of withholding or withdrawing. During the study, 69 patients died in ICU(30.9% of all the ICU death), ICU mortality was 80.2%. Compared to group A and C, group B had less surviving time and less medical expense. Conclusion The percentage of withholding or withdrawing of life-supporting treatment was not high in our ICU. The families were the major part who made the requests. Only One-third of the ICU deaths in our study were preceded by a decision to withhold or withdraw life-supporting treatment. Withdrawing life-support led to less medical expense.

Key words: end-of-life, withholding/withdrawal of life-support treatment, intensive care, ethics, decision making