Ethisch begründet entscheiden in der Intensivmedizin

Abstract

The process recommendations of the Ethics Section of the German Interdisciplinary Association for Intensive Care and Emergency Medicine (DIVI) for ethically based decision-making in intensive care medicine are intended to create the framework for a structured procedure for seriously ill patients in intensive care. The processes require appropriate structures, e.g., for effective communication within the treatment team, with patients and relatives, legal representatives, as well as the availability of palliative medical expertise, ethical advisory committees and integrated psychosocial and spiritual care services. If the necessary competences and structures are not available in a facility, they can be consulted externally or by telemedicine if necessary. The present recommendations are based on an expert consensus and are not the result of a systematic review or a meta-analysis.

Publication History

Article published online:
08 January 2024

• Literatur

• 1 Fleischmann-Struzek C, Mikolajetz A, Reinhart K. et al. Hospitalisierung und Intensivtherapie am Lebensende. Dtsch Arztebl Int 2019; 116: 653-660 DOI: 10.3238/arztebl.2019.0653.
• 2 Neitzke G, Burchardi H, Duttge G. et al. Grenzen der Sinnhaftigkeit von Intensivmedizin: Positionspapier der Sektion Ethik der DIVI. Med Klin Intensivmed Notfmed 2019; 114: 46-52 DOI: 10.1007/s00063-018-0514-y.
• 3 Van den Bulcke B, Metaxa V, Reyners AK. et al. Ethical climate and intention to leave among critical care clinicians: an observational study in 68 intensive care units across Europe and the United States. Intensive Care Med 2020; 46: 46-56 DOI: 10.1007/s00134-019-05829-1.
• 4 Davidson JE, Aslakson RA, Long AC. et al. Guidelines for family-centered care in the neonatal, pediatric, and adult ICU. Crit Care Med 2017; 45: 103-128 DOI: 10.1097/CCM.0000000000002169.
• 5 Goldfarb MJ, Bibas L, Bartlett V. et al. Outcomes of patient- and family-centered care interventions in the ICU: a systematic review and meta-analysis. Crit Care Med 2017; 45: 1751-1761 DOI: 10.1097/ccm.0000000000002624.
• 6 Girbes ARJ. Indication and Prognostication. In: Michalsen A, Sadovnikoff N. Hrsg. Compelling ethical Challengers in critical Care and Emergency Medicine. Berlin: Springer; 2020: 29-34
• 7 Kerckhoffs MC, Senekal J, van Dijk D. et al. Framework to support the process of decision-making on life-sustaining treatments in the ICU: results of a delphi study. Crit Care Med 2020; 48: 645-653 DOI: 10.1097/ccm.0000000000004221.
• 8 Neitzke G. Indikation: fachliche und ethische Basis ärztlichen Handelns. Med Klin Intensivmed Notfmed 2014; 109: 8-12
• 9 Secunda K, Wirpsa MJ, Neely KJ. et al. Use and meaning of “goals of care” in the healthcare literature: a systematic review and qualitative discourse analysis. J Gen Intern Med 2020; 35: 1559-1566 DOI: 10.1007/s11606-019-05446-0.
• 10 Donovan AL, Aldrich JM, Gross AK. et al. Interprofessional care and teamwork in the ICU. Crit Care Med 2018; 46: 980-990 DOI: 10.1097/ccm.0000000000003067.
• 11 Kon AA, Davidson JE, Morrison W. et al. Shared decision making in ICUs: an American College of Critical Care Medicine and American Thoracic Society policy statement. Crit Care Med 2016; 44: 188-201 DOI: 10.1097/CCM.0000000000001396.
• 12 Michalsen A, Long AC, DeKeyser Ganz F. et al. Interprofessional shared decision-making in the ICU: a systematic review and recommendations from an expert panel. Crit Care Med 2019; 47: 1258-1266 DOI: 10.1097/CCM.0000000000003870.
• 13 Michalsen A, Neitzke G, Dutzmann J. et al. Überversorgung in der Intensivmedizin: erkennen, benennen, vermeiden: Positionspapier der Sektion Ethik der DIVI und der Sektion Ethik der DGIIN. Med Klin Intensivmed Notfmed 2021; 116: 281-294 DOI: 10.1007/s00063-021-00794-4.
• 14 in der Schmitten J, Nauck F, Marckmann G. Behandlung im Voraus planen (Advance Care Planning): ein neues Konzept zur Realisierung wirksamer Patientenverfügungen. Z Palliativmed 2016; 17: 177-195
• 15 Krones T, Budilivschi A, Karzig I. et al. Advance care planning for the severely ill in the hospital: a randomized trial. BMJ Support Palliat Care 2019; 12: e411-e423 DOI: 10.1136/bmjspcare-2017-001489.
• 16 Turnbull AE, Hartog CS. Goal-concordant care in the ICU: a conceptual framework for future research. Intensive Care Med 2017; 43: 1847-1849 DOI: 10.1007/s00134-017-4873-2.
• 17 Bundesärztekammer/Zentrale Ethikkommission bei der Bundesärztekammer. Hinweise und Empfehlungen zum Umgang mit Vorsorgevollmachten und Patientenverfügungen im ärztlichen Alltag. Dtsch Arztebl 2018; 115: A2434-A2441
• 18 Bennett F, OʼConner-Von S. Communication interventions to improve goal-concordant care of seriously ill patients: an integrative review. J Hosp Palliat Nurs 2020; 22: 40-48 DOI: 10.1097/NJH.0000000000000606.
• 19 Kumpf O. Qualitätsindikatoren in der Intensivmedizin: Hintergrund und praktischer Nutzen. Med Klin Intensivmed Notfmed 2021; 116: 17-28 DOI: 10.1007/s00063-019-00630-w.
• 20 Stollings JL, Devlin JW, Lin JC. et al. Best practices for conducting interprofessional team rounds to facilitate performance of the ICU liberation (ABCDEF) Bundle. Crit Care Med 2020; 48: 562-570 DOI: 10.1097/CCM.0000000000004197.
• 21 Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin. Qualitätsindikatoren Intensivmedizin – 4. Auflage 2022. Im Internet (Stand: 05.12.2023): https://www.divi.de/joomlatools-files/docman-files/publikationen/peer-review/220310-qualitaetsindikatoren-intensivmedizin-divi-peer-review.pdf
• 22 Rhodes A, Moreno RP, Azoulay E. et al. Prospectively defined indicators to improve the safety and quality of care for critically ill patients: a report from the Task Force on Safety and Quality of the European Society of Intensive Care Medicine (ESICM). Intensive Care Med 2012; 38: 598-605 DOI: 10.1007/s00134-011-2462-3.
• 23 Martin-Loeches I, Wunderink RG, Nanchal R. et al. Determinants of time to death in hospital in critically ill patients around the world. Intensive Care Med 2016; 42: 1454-1460 DOI: 10.1007/s00134-016-4479-0.
• 24 Cao V, Tan LD, Horn F. et al. Patient-centered structured interdisciplinary bedside rounds in the medical ICU. Crit Care Med 2018; 46: 85-92 DOI: 10.1097/ccm.0000000000002807.
• 25 Stollings JL, Devlin JW, Pun BT. et al. Implementing the ABCDEF bundle: top 8 questions asked during the ICU liberation ABCDEF bundle improvement collaborative. Crit Care Nurse 2019; 39: 36-45 DOI: 10.4037/ccn2019981.
• 26 Curtis JR, White DB. Practical guidance for evidence-based ICU family conferences. Chest 2008; 134: 835-843 DOI: 10.1378/chest.08-0235.
• 27 Baile WF, Buckman R, Lenzi R. et al. SPIKES-A six-step protocol for delivering bad news: application to the patient with cancer. Oncologist 2000; 5: 302-311 DOI: 10.1634/theoncologist.5-4-302.
• 28 Lautrette A, Darmon M, Megarbane B. et al. A communication strategy and brochure for relatives of patients dying in the ICU. N Engl J Med 2007; 356: 469-478 DOI: 10.1056/NEJMoa063446.
• 29 Miller C, Breakwell R. What factors influence a familyʼs decision to agree to organ donation? A critical literature review. London J Prim Care (Abingdon) 2018; 10: 103-107 DOI: 10.1080/17571472.2018.1459226.
• 30 Albisser Schleger H, Mertz M, Meyer-Zehnder B, Reiter-Theil S. Klinische Ethik – METAP. Berlin: Springer; 2019
• 31 Neitzke G, Boll B, Burchardi H. et al. Dokumentation Therapiebegrenzung – Empfehlung der Sektion Ethik der Deutschen Interdisziplinäre 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 DOI: 10.1007/s00063-017-0321-x.
• 32 Nisbet G, Dunn S, Lincoln M. Interprofessional team meetings: opportunities for informal interprofessional learning. J Interprof Care 2015; 29: 426-432 DOI: 10.3109/13561820.2015.1016602.
• 33 Reeves S, Pelone F, Harrison R. et al. Interprofessional collaboration to improve professional practice and healthcare outcomes. Cochrane Database Syst Rev 2017; (06) CD000072 DOI: 10.1002/14651858.CD000072.pub3.
• 34 Meyer-Zehnder B, Barandun Schäfer U, Albisser Schleger H. et al. Ethische Fallbesprechungen auf der Intensivstation. Anaesthesist 2014; 63: 477-487 DOI: 10.1007/s00101-014-2331-x.
• 35 American College of Critical Care Medicine of the Society of Critical Care Medicine. Critical care services and personnel: recommendations based on a system of categorization into two levels of care. American College of Critical Care Medicine of the Society of Critical Care Medicine. Crit Care Med 1999; 27: 422-426
• 36 Haupt MT, Bekes CE, Brilli RJ. et al. Guidelines on critical care services and personnel: recommendations based on a system of categorization of three levels of care. Crit Care Med 2003; 31: 2677-2683 DOI: 10.1097/01.Ccm.0000094227.89800.93.
• 37 Bundesministerium für Justiz und Verbraucherschutz. Sozialgesetzbuch (SGB) Fünftes Buch (V) – Gesetzliche Krankenversicherung (Artikel 1 des Gesetzes v. 20. Dezember 1988, BGBl. I S. 2477) § 39 Krankenhausbehandlung. BGBl 2021; I: 2477
• 38 Münch U, Müller H, Deffner T. et al. Empfehlungen zur Unterstützung von belasteten, schwerstkranken, sterbenden und trauernden Menschen in der Corona Pandemie aus palliativmedizinischer Perspektive. Schmerz 2020; 34: 303-313 DOI: 10.1007/s00482-020-00483-9.
• 39 Kentish-Barnes N, Chevret S, Valade S. et al. A three-step support strategy for relatives of patients dying in the intensive care unit: a cluster randomised trial. Lancet 2022; 399: 656-664 DOI: 10.1016/s0140-6736(21)02176-0.
• 40 Adler K, Schlieper D, Kindgen-Milles D. et al. Integration der Palliativmedizin in die Intensivmedizin: Systematische Ubersichtsarbeit. Anaesthesist 2017; 66: 660-666 DOI: 10.1007/s00101-017-0326-0.
• 41 Aslakson R, Cheng J, Vollenweider D. et al. Evidence-based palliative care in the intensive care unit: a systematic review of interventions. J Palliat Med 2014; 17: 219-235 DOI: 10.1089/jpm.2013.0409.
• 42 Braus N, Campbell TC, Kwekkeboom KL. et al. Prospective study of a proactive palliative care rounding intervention in a medical ICU. Intensive Care Med 2016; 42: 54-62 DOI: 10.1007/s00134-015-4098-1.
• 43 Metaxa V, Anagnostou D, Vlachos S. et al. Palliative care interventions in intensive care unit patients. Intensive Care Med 2021; 47: 1415-1425 DOI: 10.1007/s00134-021-06544-6.
• 44 Gade G, Venohr I, Conner D. et al. Impact of an inpatient palliative care team: a randomized control trial. J Palliat Med 2008; 11: 180-190 DOI: 10.1089/jpm.2007.0055.
• 45 Ma J, Chi S, Buettner B. et al. Early palliative care consultation in the medical ICU: a cluster randomized crossover trial. Crit Care Med 2019; 47: 1707-1715 DOI: 10.1097/ccm.0000000000004016.
• 46 Okon TR, Vats HS, Dart RA. Palliative medicine referral in patients undergoing continuous renal replacement therapy for acute kidney injury. Ren Fail 2011; 33: 707-717 DOI: 10.3109/0886022X.2011.589946.
• 47 Zalenski RJ, Jones SS, Courage C. et al. Impact of palliative care screening and consultation in the ICU: a multihospital quality improvement project. J Pain Symptom Manage 2017; 53: 5-12.e3 DOI: 10.1016/j.jpainsymman.2016.08.003.
• 48 Zern EK, Young MN, Triana T. et al. Utilization of palliative care services for cardiac arrest patients undergoing therapeutic hypothermia: a retrospective analysis. Resuscitation 2017; 112: 22-27 DOI: 10.1016/j.resuscitation.2016.12.014.
• 49 Bundesärztekammer. Grundsätze der Bundesärztekammer zur ärztlichen Sterbebegleitung. Dtsch Arztebl 2011; 108: A346-A348
• 50 Nelson JE, Bassett R, Boss RD. et al. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med 2010; 38: 1765-1772 DOI: 10.1097/CCM.0b013e3181e8ad23.
• 51 Curtis JR, Vincent JL. Ethics and end-of-life care for adults in the intensive care unit. Lancet 2010; 376: 1347-1353 DOI: 10.1016/S0140-6736(10)60143-2.
• 52 Firn J, Rui C, Vercler C. et al. Identification of core ethical topics for interprofessional education in the intensive care unit: a thematic analysis. J Interprof Care 2020; 34: 453-460 DOI: 10.1080/13561820.2019.1632814.