Intensive care unit admission in chronic obstructive pulmonary disease: patient information and the physician's decision-making process

被引:16
作者
Schmidt, Matthieu [1 ,2 ,3 ]
Demoule, Alexandre [3 ,4 ,5 ]
Deslandes-Boutmy, Emmanuelle [6 ]
Chaize, Marine [7 ]
de Miranda, Sandra [7 ]
Bele, Nicolas [7 ]
Roche, Nicolas [8 ]
Azoulay, Elie [7 ]
Similowski, Thomas [1 ,2 ,3 ]
机构
[1] Univ Paris 06, Sorbonne Univ, UMR S Neurophysiol Resp Expt & Clin 1158, F-75013 Paris, France
[2] Univ Paris 06, INSERM, UMR S Neurophysiol Resp Expt & Clin 1158, F-75013 Paris, France
[3] Grp Hosp Pitie Salpetriere Charles Foix, AP HP, Serv Pneumol & Reanimat Med, Dept R3S, F-75013 Paris, France
[4] Univ Paris 06, Sorbonne Univ, UMR S 974, F-75013 Paris, France
[5] INSERM, UMR S 974, F-75005 Paris, France
[6] Hop St Louis, Hop Paris, Serv Biostat, F-75010 Paris, France
[7] Hop St Louis, Hop Paris, Serv Reanimat Med, F-75010 Paris, France
[8] Univ Paris 05, Hop Cochin, Hop Paris, Serv Pneumol & Soins Intensifs Resp, F-75014 Paris, France
来源
CRITICAL CARE | 2014年 / 18卷 / 03期
关键词
OF-LIFE CARE; MECHANICAL VENTILATION; ACUTE EXACERBATION; COMMUNICATION; COPD; END; OUTCOMES; HEALTH; DEATH; ASSOCIATIONS;
D O I
10.1186/cc13906
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Introduction: ICU admission is required in more than 25% of patients with chronic obstructive pulmonary disease (COPD) at some time during the course of the disease. However, only limited information is available on how physicians communicate with COPD patients about ICU admission. Methods: COPD patients and relatives from 19 French ICUs were interviewed at ICU discharge about their knowledge of COPD. French pulmonologists self-reported their practices for informing and discussing intensive care treatment preferences with COPD patients. Finally, pulmonologists and ICU physicians reported barriers and facilitators for transfer of COPD patients to the ICU and to propose invasive mechanical ventilation. Results: Self-report questionnaires were filled in by 126 COPD patients and 102 relatives, and 173 pulmonologists and 135 ICU physicians were interviewed. For 41% (n = 39) of patients and 54% (n = 51) of relatives, ICU admission had never been expected prior to admission. One half of patients were not routinely informed by their pulmonologist about possible ICU admission at some time during the course of COPD. Moreover, treatment options (that is, non-invasive ventilation, intubation and mechanical ventilation or tracheotomy) were not explained to COPD patients during regular pulmonologist visits. Pulmonologists and ICU physician have different perceptions of the decision-making process pertaining to ICU admission and intubation. Conclusions: The information provided by pulmonologists to patients and families concerning the prognosis of COPD, the risks of ICU admission and specific care could be improved in order to deliver ICU care in accordance with the patient's personal values and preferences. Given the discrepancies in the decision-making process between pulmonologists and intensivists, a more collaborative approach should probably be discussed.
引用
收藏
页数:9
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