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중환자실 임종기 돌봄

The End-of-Life Care in the Intensive Care Unit

문재영|신용섭
대한중환자의학회 (The Korean Society Of Critical Care Medicine)|2013.08|Acute and Critical Care|제28권 제3호|pp. 163-172

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참고문헌

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autonomypalliative careend-of-life careintensive care unitdo-not-resuscitate orderpatient-centered care.

초록

The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient’s autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient’s death in imminent. To improve understanding EOL care of terminally ill patients, we summarize ‘Recommendations for EOL care in the ICU by the American College of Critical Care Medicine’ and ‘Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science’. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

Abstract

The intensive care units (ICUs) provide the best possible medical care to help critically ill patients survive acute threats to their lives. At the same time, the ICU is also the most common place to die. Thus the ICU clinicians should be competent in all aspects for end-of-life (EOL) care. The quality of EOL care in Korean ICUs do not ensure ICU patient’s autonomy and dignity at their end-of-life. For examples, several studies present that do-not-resuscitate (DNR) orders are only initiated when the patient’s death in imminent. To improve understanding EOL care of terminally ill patients, we summarize ‘Recommendations for EOL care in the ICU by the American College of Critical Care Medicine’ and ‘Consensus guidelines to withdrawing life-sustaining therapies endorsed by Korean Academy of Medical Science’. EOL care will be emerging as a comprehensive area of expertise in Korean ICUs. The ICU clinicians must strive to find the barriers for EOL care in the ICU and develop their processes to improve the care of EOL.

참고문헌 (51)

  1. Angus DC, "Robert Wood Johnson Foundation ICU End-Of-Life Peer Group: Use of intensive care at the end of life in the United States: an epidemiologic study", Crit Care Med, 32, pp.638~643 (2004)
  2. Luce JM, "The Changing Nature of Death in the ICU. In: Managing Death in the Intensive Care Unit: The Transition From Cure to Comfort", pp.19~29 (2001), Oxford University Press
  3. Enck RE, "Intensive care unit palliative medicine: some issues- part I", Am J Hosp Palliat Care, 28, pp.73~74 (2011)
  4. The suggestion of social consensus on withdrawing a life-sustaining therapy in terminally ill patients (NECA10A-0003), "Agency NE-bHC", NECA, 494~ (2009)
  5. Yun YH, "Chemotherapy use and associated factors among cancer patients near the end of life", Oncology, 72, pp.164~171 (2007)
  6. 문재영, "연명치료 중지에 대한 내과 전공의들의 인식과 심리적 스트레스", 대한중환자의학회지, 27(1), pp.16~23 (2012), 대한중환자의학회[DOI]
  7. of Critical Care Medicine, "Crit Care Med", 2008, 953~963
  8. The Public Hearing on Legislation of Decision-making for Life-sustaining Treatment, "The Public Hearing on Legislation of Decision-making for Life-sustaining Treatment", The Special Committee on Legislation of Withdrawing or Withholding Life-sustaining Treatment, 3~64 (2013)
  9. "Commissioning End of Life Care. In: Care NCfP" (2011)[URL]
  10. Emanuel EJ, "Palliative and End-of-Life Care. In: Harrison's Principles of Internal Medicine" (2012), McGraw-Hill Companies
  11. Kahn JM, "Quality improvement in end-of-life critical care", Semin Respir Crit Care Med, 33, pp.375~381 (2012)
  12. Shin HH, "The assessment and significance of supreme court ruling on ‘boramae medical center case'", Law and Medicine, 5, pp.151~170 (2004)
  13. "2002Do995. In: Pannel-1 SC, editor. Seoul, Supreme Court. 2004", 06, pp.2004, ~
  14. "2009Da17417 Decided. In: Decision SCFP, editor. Seoul, Supreme Court. 2009", ~ (2009)
  15. Lee YS, "The consensus guideline to withhold", withdrawal of a lifesustaining therapy, 2009
  16. 박형욱, "세브란스병원 사건의 경과와 의의", 대한의사협회지, 52(9), pp.848~855 (2009), 대한의사협회
  17. 문재영, "‘대한의사협회 연명치료 중지에 관한 지침(2009)’에 대한 한국 중환자 전담의사의 인식", 한국의료윤리학회지, 14(3), pp.266~275 (2011), 한국의료윤리학회
  18. 권복규, "우리나라 일부 병원에서 환자, 보호자, 의료진의 연명치료 중지 관련 의사결정에 관한 태도", 한국의료윤리학회지, 13(1), pp.1~16 (2010), 한국의료윤리학회
  19. 고윤석, "연명치료 중지에 관한 지침의 특징과 쟁점", 대한의사협회지, 54(7), pp.747~757 (2011), 대한의사협회
  20. Downey L, "The Quality of Dying and Death Questionnaire (QODD): empirical domains and theoretical perspectives", J Pain Symptom Manage, 39, pp.9~22 (2010)
  21. Donaldson MS, "Measuring quality of care at the end of life", Arch Intern Med, 158, pp.121~128 (1998)
  22. Center NC., "Cancer Facts & Figures 2013", Director of National Cancer Center Minister of Health & Welfare, ~ (2013)
  23. 이광하, "한 내과계 중환자실에서 사망한 환자들의 심폐소생술 거절 현황", 대한중환자의학회지, 23(2), pp.84~89 (2008), 대한중환자의학회
  24. Kim do Y, "Do-not-resuscitate orders for terminal patients with cancer in teaching hospitals of Korea", J Palliat Med, 10, pp.1153~1158 (2007)
  25. Lee JK, "Surrogate decision-making in Korean patients with advanced cancer: a longitudinal study", Support Care Cancer, 21, pp.183~190 (2013)
  26. 허대석, "환자의 자기결정권과 사전의료지시서", 대한의사협회지, 52(9), pp.865~870 (2009), 대한의사협회
  27. 고윤석, "한 대학병원에 근무하는 전공의들의 의료윤리 교육에 관한 경험 및 인식도 조사", 한국의료윤리학회지, 10(2), pp.109~116 (2007), 한국의료윤리학회
  28. Moon JY, "The experience of ethics consultation model for a tertiary referral hospital intensive care units" (2013), Univ. of Ulsan College of Medicine
  29. 김중호, "병원윤리위원회 조직과 기능 및 활성화 방안 연구", 한국의료윤리학회지, 7(1), pp.47~63 (2004), 한국의료윤리학회
  30. Kang JM, "Analysis of cases requested to the ethics committee of an university hospital for the discontinuation of therapy", Korean J Crit Care Med, 20, pp.68~75 (2005)
  31. Kang HH, "Study on strengthening hospital ethics committee", 석사, pp.2009
  32. Robinson R, "Registered nurses and moral distress", Dimens Crit Care Nurs, 29, pp.197~202 (2010)
  33. Pauly B, "Registered nurses' perceptions of moral distress and ethical climate", Nurs Ethics, 16, pp.561~573 (2009)
  34. Hamric AB, "Nurse-physician perspectives on the care of dying patients in intensive care units: collaboration, moral distress, and ethical climate", Crit Care Med, 35, pp.422~429 (2007)
  35. DeKeyser Ganz F, "Surgical nurses' perceptions of ethical dilemmas, moral distress and quality of care", J Adv Nurs, 68, pp.1516~1525 (2012)
  36. Piers RD, "APPROPRICUS Study Group of the Ethics Section of the ESICM: Perceptions of appropriateness of care among European and Israeli intensive care unit nurses and physicians", JAMA, 306, pp.2694~2703 (2011)
  37. Adolph MD, "Palliative critical care in the intensive care unit: a 2011 perspective", Int J Crit Illn Inj Sci, 1, pp.147~153 (2011)
  38. Aulisio MP, "Ethics and palliative care consultation in the intensive care unit", Crit Care Clin, 20, pp.505~523 (2004)
  39. 김정현, "임종을 앞둔 환자의 임상양상과 처치", 대한의사협회지, 52(7), pp.697~704 (2009), 대한의사협회
  40. A controlled trial to improve care for seriously ill hospitalized patients, "The study to understand prognoses and preferences for outcomes and risks of treatments (SUPPORT). The SUPPORT Principal Investigators", JAMA, 274, pp.1591~1598 (1995)
  41. Novaes MA, "Stressors in ICU: patients' evaluation", Intensive Care Med, 23, pp.1282~1285 (1997)
  42. Nelson JE, "Critical Care Peer Workgroup of the Promoting Excellence in End-of-Life Care Project: End-of-life care for the critically ill: a national intensive care unit survey", Crit Care Med, 34, pp.2547~2553 (2006)
  43. Curtis JR, "Ethics and end-of-life care for adults in the intensive care unit", Lancet, 376, pp.1347~1353 (2010)
  44. Jox RJ, "Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians", J Med Ethics, 38, pp.540~545 (2012)
  45. "Death rates for selected causes of death for all ages, by sex: United States, 1998-2008"[URL]
  46. Korea S., "Statistics for Causes of death in Korea", ~ (2011)
  47. 배종면, "전국 의료기관의 연명치료 대상자 입원 현황", 대한중환자의학회지, 25(1), pp.16~20 (2010), 대한중환자의학회
  48. Sprung CL, "Ethicus Study Group: End-of-life practices in European intensive care units: the Ethicus Study", JAMA, 290, pp.790~797 (2003)
  49. Prendergast TJ, "A national survey of end-of-life care for critically ill patients", Am J Respir Crit Care Med, 158, pp.1163~1167 (1998)
  50. Ferris FD, "A Model to Guide Hospice Palliative Care: Based on National Principles and Norms of Practice", Ottawa, Ontario, Canada, ~ (2002)
  51. Fair allocation of intensive care unit resources, "American thoracic society", Am J Respir Crit Care Med, 156, pp.1282~1301 (1997)

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