Læknablaðið - 15.06.1997, Page 23

LÆKNABLAÐIÐ 1997; 83
383
Takmörkun meðferðar á
gjörgæsludeild
Erla G. Sveinsdóttir, Ólafur Þ. Jónsson
Sveinsdóttir EG, Jónsson ÓÞ
Limitation of treatment in a critical care unit
Læknablaðið 1997; 83: 383-8
Background and objective: Increased medical and
technical knowledge has saved the lives of more
patients than was possible a few decades ago. This
has also raised many ethical questions. It is now
regarded to be justifiable to limit treatment for some
terminally ill patients because certain treatment op-
tions are not felt to be in the patient’s best interest.
At The Reykjavík Hospital guidelines regarding the
limitation of treatment were instituted in 1992. This
study was undertaken to find out how these guide-
lines were implemented, how often treatment was
limited, what reasons were given and how the docu-
mentation was carried out.
Material and methods: Included were all patients in
the intensive care unit for whom treatment was lim-
ited in the year 1993. When the decision was made to
limit treatment a questionnaire was filled out. In-
formation was recorded from this and the medical
record.
Results: There were 606 patients admitted to the
intensive care unit in 1993. Decisions to limit treat-
ment were made for 25 patients (4%). The mean age
was 67.6 years. The reasons for limiting treatment
were neurological deficit in 15 patients, multiple
organ failure in seven patients and circulatory fail-
ure in three patients. The decision to limit treatment
was made most frequently by the patient’s primary
hospital physician after consultation with the in-
tensive care physician on call and the patient's rela-
tives. Twenty-two of the patients were unconscious
Frá svæfinga- og gjörgæsludeild Sjúkrahúss Reykjavíkur,
Fossvogi. Fyrirspurnir og bréfaskipti: Ólafur Þ. Jónsson,
svæfinga- og gjörgæsludeild Sjúkrahúss Reykjavíkur,
Fossvogi, 108 Reykjavík.
Lykilorð: meðferð í lok lífs, takmörkun meðferðar, gjör-
gæsla, læknisfræðileg siðfræði.
when the decision to limit treatment was made.
Twenty-one died in the intensive care unit and four
were discharged to a general patient ward.
Discussion: Comparing our findings with those of
similar studies in other countries it was found that
the decision to limit care in our institution was made
less frequently and, if made occurred later in the
course of the patient’s care. The documentation was
considered to be less than optimal in some cases.
Key words: Terminal care, do-not-resuscitate, pallative
care, intensive care unit, medical ethics.
Correspondence: Ólafur Þ. Jónsson, The Department of
Anaesthesia and Intensive Care, The Reykjavík Hospital,
108 Reykjavík, lceland.
Ágrip
Inngangur: Aukin þekking í læknisfræði og
tækni gerir kleift að bjarga lífi fleiri sjúklinga
en áður. Ymis siðfræðileg viðhorf hafa einnig
breyst og við sérstakar aðstæður getur komið
til álita að takmarka meðferð. Á Borgarspítal-
anum voru leiðbeiningar um takmörkun á
meðferð formlega teknar upp árið 1992 og í
framhaldi af því gerð könnun. Tilgangurinn
var að athuga hversu oft takmörkun á meðferð
sjúklinga var beitt á gjörgæsludeild, hverjar
voru ástæður, hverjir tóku ákvörðunina,
hvernig skráningu var háttað og hvernig leið-
beiningarnar voru notaðar.
Efniviður og aðferðir: Sjúklingar á gjör-
gæsludeild spítalans sem fengu takmarkaða
meðferð árið 1993. Þegar slík ákvörðun lá fyrir
var fyllt út til þess gert eyðublað sem síðan var
yfirfarið ásamt sjúkraskrám viðkomandi sjúk-
linga.
Niðurstöður: Árið 1993 innrituðust 606
sjúklingar á gjörgæsludeild Borgarspítalans.
Meðferð var takmörkuð hjá 25 sjúklingum
(4%). Meðalaldur var 67,6 ár. Ástæður fyrir
takmörkun á meðferð voru vanstarfsemi