[重症监护室的舒适临终关怀:实践建议]。

Die Anaesthesiologie Pub Date : 2024-03-01 Epub Date: 2024-02-05 DOI:10.1007/s00101-024-01382-9
Eva Schaden, Helga Dier, Dietmar Weixler, Walter Hasibeder, Andrea Lenhart-Orator, Christian Roden, Sonja Fruhwald, Barbara Friesenecker
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引用次数: 0

摘要

背景和目的:奥地利麻醉学、复苏和重症监护医学会(ÖGARI)麻醉和重症监护医学伦理工作组早在十年前就开发了用于调整治疗目标的文件工具。从那时起,舒适末期护理在日常工作中的实际实施尤其引发了许多问题,本后续论文将对这些问题进行讨论,并尽可能以循证方式予以解答:结果:本文更详细地介绍了舒适临终关怀中疼痛治疗和减轻焦虑、压力和呼吸窘迫的具体实施方法。此外,还对不适用(或不再适用)的措施进行了评论,如供氧和通气以及输液和营养。此外,还就监测、(实验室)结果和药物治疗提出了建议,并提到了舒适临终关怀中护理行动的重要性。最后,介绍了对近亲的支持和死后的程序:讨论:改变治疗目标,及时转为舒适临终关怀,可以在生命的最后阶段为重症患者及其亲属提供良好的人性化护理,并使他们在临终前仍有可能获得积极的人生体验。
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[Comfort Terminal Care in the intensive care unit: recommendations for practice].

Background and objective: The Working Group on Ethics in Anesthesia and Intensive Care Medicine of the Austrian Society for Anesthesiology Resuscitation and Intensive Care Medicine (ÖGARI) already developed documentation tools for the adaption of therapeutic goals 10 years ago. Since then the practical implementation of Comfort Terminal Care in the daily routine in particular has raised numerous questions, which are discussed in this follow-up paper and answered in an evidence-based manner whenever possible.

Results: The practical implementation of pain therapy and reduction of anxiety, stress and respiratory distress that are indicated in the context of Comfort Terminal Care are described in more detail. The measures that are not (or no longer) indicated, such as oxygen administration and ventilation as well as the administration of fluids and nutrition, are also commented on. Furthermore, recommendations are given regarding monitoring, (laboratory) findings and drug treatment and the importance of nursing actions in the context of Comfort Terminal Care is mentioned. Finally, the support for the next of kin and the procedure in the time after death are presented.

Discussion: A change in treatment goals with a timely switch to Comfort Terminal Care enables good and humane care for seriously ill patients and their relatives at the end of life and the appreciation of their previous life with the possibility of positive experiences until the end.

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