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Titolo:
WITHHOLDING AND WITHDRAWING OF LIFE-SUPPORT FROM PATIENTS WITH SEVEREHEAD-INJURY
Autore:
OCALLAHAN JG; FINK C; PITTS LH; LUCE JM;
Indirizzi:
UNIV CALIF SAN FRANCISCO,SCH MED,DEPT MED SAN FRANCISCO CA 94143 UNIV CALIF SAN FRANCISCO,SCH MED,DEPT NEUROL SURG SAN FRANCISCO CA 94143 UNIV CALIF SAN FRANCISCO,SCH NURSING SAN FRANCISCO CA 94143 SAN FRANCISCO GEN HOSP SAN FRANCISCO CA 94110
Titolo Testata:
Critical care medicine
fascicolo: 9, volume: 23, anno: 1995,
pagine: 1567 - 1575
SICI:
0090-3493(1995)23:9<1567:WAWOLF>2.0.ZU;2-Q
Fonte:
ISI
Lingua:
ENG
Soggetto:
CRITICALLY ILL PATIENTS; NOT-RESUSCITATE ORDERS; CLASSIFICATION-SYSTEM; CLINICAL EXAMINATION; COMA SCALE; PROGNOSIS; CHILDREN; PRINCIPLES; PREDICTION; DECISIONS;
Keywords:
HEAD INJURY; LIFE-SUPPORT CARE; TRAUMA; RESUSCITATION ORDERS; MEDICAL ETHICS; NEUROLOGIC EMERGENCIES;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Science Citation Index Expanded
Citazioni:
33
Recensione:
Indirizzi per estratti:
Citazione:
J.G. Ocallahan et al., "WITHHOLDING AND WITHDRAWING OF LIFE-SUPPORT FROM PATIENTS WITH SEVEREHEAD-INJURY", Critical care medicine, 23(9), 1995, pp. 1567-1575

Abstract

Objective: To characterize the withholding or withdrawing of life support from patients with severe head injury. Setting: San Francisco General Hospital, a city and county hospital with a Level I trauma center. Design: A standardized questionnaire was used to collect data on demographics and functional outcome of severely head-injured (Glasgow Coma Score less than or equal to 7) patients admitted to the medical-surgical intensive care unit, and to interview the patients' physician andfamily members. Patients: Forty-seven patients who were admitted to amedical-surgical intensive care unit over a 1-yr period. Interventions: Twenty-four patients had life support withheld or withdrawn, and 23patients did not. Measurements and Main Results: Physician and familyseparately assessed patient's probable functional outcome, degree of communication between them, reasons important in recommending or deciding on discontinuation of life support, and the result of action taken. Six months later, the families reviewed the process of their decision, how well physician(s) had communicated, and what might have improved communication. Of 24 patients with life support discontinued, 22 died; two were discharged from the hospital. Twenty-three of the 24 patients had a poor prognosis on admission. Of the 23 patients who were continued on life support for the duration of their hospitalization, ten had a poor (p < .001) prognosis on admission. Prognosis improved for two patients from the first group and five from the latter. Family's assessment of prognosis agreed with physician's assessment in 22 of the 24 patients from whom life support was discontinued (p < .001). Physicians' ability to convey the prognosis appeared to influence families' assessments. Physicians' considerations in recommending limitation of care and families' considerations in making decisions were the same, primarily an inevitably poor prognosis. Neither physician nor families cited cost or availability of care as a deciding factor. Two families disagreed with the recommendation to limit care after initial agreement because the patients' prognosis improved from ''likely death'' to ''vegetative. '' Care was therefore continued, and both patients remainedvegetative 6 months after admission to the hospital and discharge to chronic care facilities. Conclusions: Life support is commonly withheld or withdrawn from patients with severe head injury at San Francisco General Hospital, and usually it is accompanied by death. A reciprocalconsideration exists in most cases between the physician and family making the difficult decision to limit care. Care is provided for patients whose families request it despite physician recommendations.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 30/10/20 alle ore 09:40:36