Retrospective agreement and consent to neurocritical care is influenced by functional outcome 英文参考文献.docVIP
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Retrospective agreement and consent to neurocritical care is influenced by functional outcome 英文参考文献
Kiphuthetal.CriticalCare2010,14:R144
/content/14/4/R144
RESEARCH
OpenAccess
Retrospectiveagreementandconsentto
neurocriticalcareisinfluencedbyfunctional
outcome
InesCKiphuth*,MartinK?hrmann,JojiBKuramatsu,ChristophMauer,LorenzBreuer,PeterDSchellinger,
StefanSchwab,HagenBHuttner
Abstract
Introduction:Onlylimiteddataareavailableonconsentandsatisfactionofpatientsreceivingspecialized
neurocriticalcare.Inthisstudywe(i)analyzedtheextentofretrospectiveconsenttoneurocriticalcare–givenby
patientsortheirrelatives–dependingonfunctionaloutcomeoneyearafterhospitalstay,and(ii)identified
predisposingfactorsforretrospectiveagreementtoneurocriticalcare.
Methods:Weinvestigated704consecutivepatientsadmittedtoanonsurgicalneurocriticalcareunitoveraperiod
of2years(2006through2007).Demographicandclinicalparameterswereanalyzed,andthepatientswere
groupedaccordingtotheirdiagnosis.Functionaloutcome,retrospectiveconsenttoneurocriticalcare,and
satisfactionwithhospitalstaywasobtainedbymailedstandardizedquestionnaires.Logisticregressionanalyses
werecalculatedtodetermineindependentpredictorsforconsent.
Results:Highconsentandsatisfactionafterneurointensivecare(91%and90%,respectively)wasobservedby
thosepatientswhoreachedanindependentlifeoneyearafterneurointensivecareunit(ICU)stay.However,only
19%ofsurvivingpatientswhowerefunctionallydependentretrospectivelyagreedtoneurocriticalcare.
Unfavorablefunctionaloutcomeandthediagnosisofstrokewereindependentpredictorsformissingretrospective
consent.
Conclusions:Retrospectiveagreementtoneurocriticalcareisinfluencedbyfunctionaloutcome.Especiallyin
severelyaffectedstrokepatientswhocannotcommunicatetheirpreferencesregardinglife-sustainingtherapy,
neurocriticalcarephysiciansshouldbalancetheexpectedburdensandbenefitsoftreatmenttomeetthepatients’
putativewishes.Effortsshouldbeundertakentoidentifypredictorsforseveredisabilityafterneurocriticalcare.
Introduction
patientsinneedofintensivecare,however,maynotbe
Inthepast,physiciansdidnotroutinelyseekpermission ca
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