Vorsorgeplanung am Lebensende aus intensivmedizinischer Sicht

In den vergangenen Jahren hat die Zahl intensivmedizinischer Behandlungen am Lebensende in beachtlichem Umfang zugenommen. Mittlerweise hat etwa jeder 4. Patient, der im Krankenhaus stirbt, zuvor eine Intensivtherapie erhalten [1]. Diese Tatsache macht deutlich, wie wichtig eine Vorsorgeplanung aus intensivmedizinischer Sicht ist, um den Therapiewünschen am Lebensende möglichst zu entsprechen.

Abstract

In recent years, the number of intensive care treatments has increased significantly. About every fourth patient who dies in hospital receives intensive care. Structured prevention planning is important in order to implement the patient’s wishes in situations of serious illness in which patients cannot express their wishes themselves. However, the implementation in practice can be problematic since intensive care situations are complex and rarely correspond to the concrete pre-arranged situations. Communication of the prognosis and the prognostic uncertainty is therefore crucial in order to determine the presumed will of the patient, especially in the context of the process of weighing up the benefits and burdens of intensive care therapies. Hospital treatment can be the reason for targeted preventive planning and avoid unnecessary intensive care treatment during the same stay. Documentation templates can help to record the results of preventive care planning clearly and comprehensibly in the medical file.

Schlüsselwörter

Vorsorgeplanung - Intensivmedizin - Therapieentscheidung - prognostische Unsicherheit - Prognose

Keywords

retirement planning - intensive care - therapy decision - prognostic uncertainty - forecast

Publication History

Article published online:
11 October 2023

• Literatur

• 1 Fleischmann-Struzek C, Mikolajetz A, Reinhart K. et al. Hospitalisierung und Intensivtherapie am Lebensende. Dtsch Arztebl Int 2019; 116: 653-660
• 2 Dutzmann J, Michalsen A, Duttge G. et al. Ehegattennotvertretungsrecht. Dtsch Med Wochenschr 2023; 148: 499-502
• 3 Khandelwal N, Curtis JR. Economic implications of end-of-life care in the ICU. Curr Opin Crit Care 2014; 20: 656-661
• 4 Khandelwal N, Benkeser DC, Coe NB. et al. Potential Influence of Advance Care Planning and Palliative Care Consultation on ICU Costs for Patients with Chronic and Serious Illness. Crit Care Med 2016; 44: 1474
• 5 De Heer G, Saugel B, Sensen B. et al. Patientenverfügungen und Vorsorgevollmachten bei Intensivpatienten. Dtsch Arztebl Int 2017; 114: 363-370
• 6 Langer S, Knorr J-U, Berg A. Umgang mit Patientenverfügungen: Probleme durch pauschale Formulierungen. Dtsch Arztebl 2013; 110: A-2186
• 7 Booth MG, Doherty P, Fairgrieve R. et al. Relatives’ knowledge of decision making in intensive care. J Med Ethics 2004; 30: 459-462
• 8 Schenker Y, Crowley-Matoka M, Dohan D. et al. I don’t want to be the one saying "we should just let him die": intrapersonal tensions experienced by surrogate decision makers in the ICU. J Gen Intern Med 2012; 27: 1657-1665
• 9 Shif Y, Doshi P, Almoosa KF. What CPR means to surrogate decision makers of ICU patients. Resuscitation 2015; 90: 73-78
• 10 Zier LS, Sottile PD, Hong SY. et al. Surrogate decision makers’ interpretation of prognostic information: a mixed-methods study. Ann Intern Med 2012; 156: 360-366
• 11 Zier LS, Burack JH, Micco G. et al. Doubt and belief in physicians’ ability to prognosticate during critical illness: the perspective of surrogate decision makers. Crit Care Med 2008; 36: 2341-2347
• 12 Anderson WG, Cimino JW, Ernecoff NC. et al. A multicenter study of key stakeholders’ perspectives on communicating with surrogates about prognosis in intensive care units. Ann Am Thorac Soc 2015; 12: 142-152
• 13 Char SJL, Evans LR, Malvar GL. et al. A randomized trial of two methods to disclose prognosis to surrogate decision makers in intensive care units. Am J Respir Crit Care Med 2010; 182: 905-909
• 14 Jöbges S, Seidlein A-H, Knochel K. et al. Zeitlich begrenzter Therapieversuch (time-limited trial, TLT) auf der Intensivstation. Eine Handlungsempfehlung der Sektion Ethik der DIVI und der Sektion Ethik der DGIIN. zur Publikation eingereicht.
• 15 Chang DW, Neville TH, Parrish J. et al. Evaluation of time-limited trials among critically ill patients with advanced medical illnesses and reduction of nonbeneficial ICU treatments. JAMA Intern Med 2021; 181: 786-794
• 16 Detering KM, Hancock AD, Reade MC. et al. The impact of advance care planning on end of life care in elderly patients: randomised controlled trial. BMJ 2010; 340: 847
• 17 Khandelwal N, Kross EK, Engelberg RA. et al. Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med 2015; 43: 1102-1111
• 18 Yamamoto K, Yonekura Y, Hayama J. et al. Advance Care Planning for Intensive Care Patients During the Perioperative Period: A Qualitative Study. SAGE Open Nurs 2021; 7
• 19 Yamamoto K, Yonekura Y, Nakayama K. Healthcare providers’ perception of advance care planning for patients with critical illnesses in acute-care hospitals: a cross-sectional study. BMC Palliat Care 2022; 21
• 20 Neitzke G, Böll B, Burchardi H. et al. Dokumentation der Therapiebegrenzung. Empfehlung der Sektion Ethik der Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin (DIVI) unter Mitarbeit der Sektion Ethik der Deutschen Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN). Med Klin Intensivmed Notfmed 2017; 112: 527-530