David Lai, Ryan Ruiyang Ling, Claire Michel, Daniel Hwang, Tapan Parikh, Yannick Planche, Ryo Ueno, David Pilcher, Ashwin Subramaniam
{"title":"在ICU期间有新的和/或更新护理目标的患者的患病率、时间和预测因素：一项多中心回顾性研究","authors":"David Lai, Ryan Ruiyang Ling, Claire Michel, Daniel Hwang, Tapan Parikh, Yannick Planche, Ryo Ueno, David Pilcher, Ashwin Subramaniam","doi":"10.1097/CCM.0000000000006663","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>Timely documentation of patient-concordant goals of care (GOC) in the ICU aims to promote patient autonomy and patient-centered care where the harms of interventions outweigh the potential benefits. This study examined the prevalence, timing, and predictors of ICU patients undergoing new and updated GOC documentation events while in the ICU.</p><p><strong>Design: </strong>Multicenter retrospective study.</p><p><strong>Setting and patients: </strong>All adults admitted to four ICUs from July 1, 2023, to December 31, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcomes: </strong>The primary outcome was to determine the prevalence, timing, and predictors of new-GOC and updated-GOC documentation events following ICU admission.</p><p><strong>Measurements and main results: </strong>We used multivariable logistic regression to identify predictors for new-GOC or updated-GOC documentation events using a backward stepwise elimination. Of the 2130 patients included, 13.3% (n = 284) had a new-GOC documentation event, and 16.3% (n = 346) had an updated-GOC documentation event. New-GOC events occurred sooner than updated-GOC events (median [interquartile range]: 18.3 [7.8-70.5] vs 73.7 [22.7-157.8] hr). Factors associated with GOC documentation events included age (odds ratio [OR] = 1.02, 95% CI, 1.01-1.03), frailty (OR = 1.30; 95% CI, 1.16-1.46), Sequential Organ Failure Assessment (SOFA) (OR = 1.23, 95% CI, 1.17-1.29), metastatic cancer (OR = 3.69, 95% CI, 2.17-6.26), ICU admission post medical emergency team review (OR = 1.94, 95% CI, 1.40-2.69), and cardiac arrest (OR = 2.23, 95% CI, 1.22-4.06) and if pre-ICU GOC had established treatment limitations, namely selective treatment goals (OR = 4.33, 95% CI, 3.18-5.90) or comfort-based treatment goals (OR = 7.66, 95% CI, 2.72-21.61). Apart from SOFA, all other factors remained significantly associated with GOC documentation events, even after accounting for ICU mortality as a competing outcome.</p><p><strong>Conclusions: </strong>Almost 30% of patients had new- or updated-GOC documentation events while in ICU. Increasing age, higher SOFA scores, metastatic cancer, frailty, cardiac arrest, and ICU admission post-MET review predicted GOC changes while in ICU.</p>","PeriodicalId":10765,"journal":{"name":"Critical Care Medicine","volume":" ","pages":""},"PeriodicalIF":7.7000,"publicationDate":"2025-03-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Prevalence, Timing, and Predictors of Patients Who Had New and/or Updated Goals of Care While in ICU: A Multicenter Retrospective Study.\",\"authors\":\"David Lai, Ryan Ruiyang Ling, Claire Michel, Daniel Hwang, Tapan Parikh, Yannick Planche, Ryo Ueno, David Pilcher, Ashwin Subramaniam\",\"doi\":\"10.1097/CCM.0000000000006663\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>Timely documentation of patient-concordant goals of care (GOC) in the ICU aims to promote patient autonomy and patient-centered care where the harms of interventions outweigh the potential benefits. This study examined the prevalence, timing, and predictors of ICU patients undergoing new and updated GOC documentation events while in the ICU.</p><p><strong>Design: </strong>Multicenter retrospective study.</p><p><strong>Setting and patients: </strong>All adults admitted to four ICUs from July 1, 2023, to December 31, 2023.</p><p><strong>Interventions: </strong>None.</p><p><strong>Main outcomes: </strong>The primary outcome was to determine the prevalence, timing, and predictors of new-GOC and updated-GOC documentation events following ICU admission.</p><p><strong>Measurements and main results: </strong>We used multivariable logistic regression to identify predictors for new-GOC or updated-GOC documentation events using a backward stepwise elimination. Of the 2130 patients included, 13.3% (n = 284) had a new-GOC documentation event, and 16.3% (n = 346) had an updated-GOC documentation event. New-GOC events occurred sooner than updated-GOC events (median [interquartile range]: 18.3 [7.8-70.5] vs 73.7 [22.7-157.8] hr). Factors associated with GOC documentation events included age (odds ratio [OR] = 1.02, 95% CI, 1.01-1.03), frailty (OR = 1.30; 95% CI, 1.16-1.46), Sequential Organ Failure Assessment (SOFA) (OR = 1.23, 95% CI, 1.17-1.29), metastatic cancer (OR = 3.69, 95% CI, 2.17-6.26), ICU admission post medical emergency team review (OR = 1.94, 95% CI, 1.40-2.69), and cardiac arrest (OR = 2.23, 95% CI, 1.22-4.06) and if pre-ICU GOC had established treatment limitations, namely selective treatment goals (OR = 4.33, 95% CI, 3.18-5.90) or comfort-based treatment goals (OR = 7.66, 95% CI, 2.72-21.61). Apart from SOFA, all other factors remained significantly associated with GOC documentation events, even after accounting for ICU mortality as a competing outcome.</p><p><strong>Conclusions: </strong>Almost 30% of patients had new- or updated-GOC documentation events while in ICU. Increasing age, higher SOFA scores, metastatic cancer, frailty, cardiac arrest, and ICU admission post-MET review predicted GOC changes while in ICU.</p>\",\"PeriodicalId\":10765,\"journal\":{\"name\":\"Critical Care Medicine\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":7.7000,\"publicationDate\":\"2025-03-31\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Critical Care Medicine\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1097/CCM.0000000000006663\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Critical Care Medicine","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1097/CCM.0000000000006663","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Prevalence, Timing, and Predictors of Patients Who Had New and/or Updated Goals of Care While in ICU: A Multicenter Retrospective Study.
Objectives: Timely documentation of patient-concordant goals of care (GOC) in the ICU aims to promote patient autonomy and patient-centered care where the harms of interventions outweigh the potential benefits. This study examined the prevalence, timing, and predictors of ICU patients undergoing new and updated GOC documentation events while in the ICU.
Design: Multicenter retrospective study.
Setting and patients: All adults admitted to four ICUs from July 1, 2023, to December 31, 2023.
Interventions: None.
Main outcomes: The primary outcome was to determine the prevalence, timing, and predictors of new-GOC and updated-GOC documentation events following ICU admission.
Measurements and main results: We used multivariable logistic regression to identify predictors for new-GOC or updated-GOC documentation events using a backward stepwise elimination. Of the 2130 patients included, 13.3% (n = 284) had a new-GOC documentation event, and 16.3% (n = 346) had an updated-GOC documentation event. New-GOC events occurred sooner than updated-GOC events (median [interquartile range]: 18.3 [7.8-70.5] vs 73.7 [22.7-157.8] hr). Factors associated with GOC documentation events included age (odds ratio [OR] = 1.02, 95% CI, 1.01-1.03), frailty (OR = 1.30; 95% CI, 1.16-1.46), Sequential Organ Failure Assessment (SOFA) (OR = 1.23, 95% CI, 1.17-1.29), metastatic cancer (OR = 3.69, 95% CI, 2.17-6.26), ICU admission post medical emergency team review (OR = 1.94, 95% CI, 1.40-2.69), and cardiac arrest (OR = 2.23, 95% CI, 1.22-4.06) and if pre-ICU GOC had established treatment limitations, namely selective treatment goals (OR = 4.33, 95% CI, 3.18-5.90) or comfort-based treatment goals (OR = 7.66, 95% CI, 2.72-21.61). Apart from SOFA, all other factors remained significantly associated with GOC documentation events, even after accounting for ICU mortality as a competing outcome.
Conclusions: Almost 30% of patients had new- or updated-GOC documentation events while in ICU. Increasing age, higher SOFA scores, metastatic cancer, frailty, cardiac arrest, and ICU admission post-MET review predicted GOC changes while in ICU.
期刊介绍：
Critical Care Medicine is the premier peer-reviewed, scientific publication in critical care medicine. Directed to those specialists who treat patients in the ICU and CCU, including chest physicians, surgeons, pediatricians, pharmacists/pharmacologists, anesthesiologists, critical care nurses, and other healthcare professionals, Critical Care Medicine covers all aspects of acute and emergency care for the critically ill or injured patient.
Each issue presents critical care practitioners with clinical breakthroughs that lead to better patient care, the latest news on promising research, and advances in equipment and techniques.
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