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Master Thesis

Gestion de la fin de vie en réanimation : enquête nationale de pratiques

Abstract : Purpose: in France, death after decision to withdrawal or withholding sustaining life therapies concerns about 10% of intensive care unit (ICU) patients. Clayes-Leonetti law published in 2016 intend to frame our medical exercise. The purpose of this study is to review the current practice concerning end of life (EOL) management in French ICU.
Methods: two national surveys were conduct, the first one consisted in 30 multiple choices questions about epidemiology, EOL decisions making, care organization and self opinion sent by mail to senior physicians members of Société Française d’Anesthésie Réanimation (SFAR). Evaluation of practices on analgesia and sedation was conduct with two clinical cases. The second survey consisted in 24 multiples choices questions sent by mail to residents members of SFAR jeunes.
Results: between October 2016 and October 2017, 695 physicians participated to the study. They majority work in a medico surgical unit in an University Center. Withholding and withdrawal life sustaining therapies decisions occur after collegial meeting (88%), a third doesn’t report decision in medical record, 46% always include medical third in decision making and only a third of physicians collect anticipate directive. Majority of them continue support care on these patients. In half of cases they haven’t sedation and analgesia protocol. Only 5% of physicians are completely satisfied of EOL care, where a better pain monitoring support is expected.
Conclusion: heterogeneity for EOL management is important between physicians, we need to improve care and set up protocols to help physicians particularly concerning analgesia and sedation.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-02613835
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Submitted on : Wednesday, May 20, 2020 - 2:15:18 PM
Last modification on : Wednesday, June 3, 2020 - 3:27:10 AM

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Julie Garcia. Gestion de la fin de vie en réanimation : enquête nationale de pratiques. Human health and pathology. 2019. ⟨dumas-02613835⟩

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