Research On End-of-life Decision Of ICU Patients In Kunming

Objective:Research on different end-of-life decision making of Intensive Care Unit(ICU)patients,including withhold life-support treatment(WH-LST)and withdraw-life support treatment(WD-LST);analysis different factors(including gender,age,ethnic customs,religious beliefs,assessment,ICU hospitalization expenses and payment)effect on end-of-life decisions of ICU patients.Methods:Collect the patients who treated in Emergency Intensive Care Unit(EICU)/Medical intensive care unit(MICU)of the first affiliated hospital of Kunming Medical University from February 2016 to January 2017.Collect the their general situation,including sex,age,time of admitted ICU,discharged ICU time,hospitalized time of ICU,admitted and discharged clinical diagnosis of ICU(according to importance),Acute Physiology and Chronic Health Evaluation ?(APACHE ?)and Reaction Level Scale(RLS)at the time of decision-making,the total amount of medical consumption and the daily cost of diagnosis and treatment,the mode of payment.The contents of the withhold(WH)/withdraw(WD)medical measures,including the relationship between the decision-makers and the patients;the content of the implementation;the time of implementation;the decision maker's religion,ethnicity,etc.According to the relevant contents,the patients who implemented WH/WD were compared in groups or with the routine treatment(RT)patients during the study period,and the binary logistic regression analysis was used to determine the related factors of the implementation of WH/WD-LST.Results:During the study period,there were 150 patients had been implemented WH/WD-LST,accounting for 15.62%of ICU patients in the same period.The main contents of life support therapy were mainly emergency resuscitation measures,84 cases withheld chest compression(56.00%)and the same as withheld defibrillation(56.00%),72cases(48.00%)withheld salvage drug injection.The main contents of the withdrawal of life support treatment were withdrew invasive operation in 31 cases(20.67%),withdrew self paid medicine in 29 cases(19.33%),withdrew nutritional support in 19 cases(12.67%)and using vasoactive drugs in 16 cases(10.67%).Compared with the conventional treatment group,the WHAVD-LST group had no difference in gender,ethnicity,religious belief and payment.In group WH/WD-LST,there were 91 male patients which accounted for 60.70%(vs RT 61.40%,P=0.873),18 patients were ethnic minorities which accounted for 12%(vs RT 12.50%,P=0.535),120 patients were non-believers which accounted for 80%(vs RT 77.80%,P=0.939),and 54 patients were paid by the urban employees' basic medical insurance,which accounted for 36.00%(vs RT 40.20%,P=0.726).However,there were significant differences in patients' age,length of stay ICU,state scores and medical expenses.The patients in group WH/WD-LST were older,75(66,83)years old[vs RT 63(54,72)years old,P=0.000];APACHE ? score and RLS level were both higher,28(25,33)[vs RT 25(22,27)P=0.000]and 6(5,8)[vs RT2(1,3),P=0.000].The total cost of ICU medical treatment in group WH/WD-LST was lower,which was 41.40(18.40,115.50)thousand yuan[vs RT 48.10(13.20,122.50)thousand yuan,P=0.734],but the daily cost of diagnosis and treatment was higher,which was 5.30(4.30,7.90)thousand yuan[vs RT 5.20(2.20,8.20)thousand yuan,P=0.004].The binary logistic regression analysis showed that the independent influencing factors of WH/WD-LST implementation included age,APACHE ? score,RLS level,and daily cost of diagnosis and treatment.Conclusion:1.the content of the implementation of WH/WD-LST is mostly WH,withhold the rescue measures(such as chest compression,electric defibrillation).2.the implementation of WH/WD-LST was closely related to the patient's age,APACHE ?score,RLS level and ICU daily cost of diagnosis and treatment.