Skip to main content
SpringerLink
Log in

Therapiebegrenzung unter besonderen Umständen: Postoperative Phase

  • Chapter
  • First Online:
End-of-Life Care in der Intensivmedizin

  • 3900 Accesses

Zusammenfassung

Entscheidungen zur Therapiebegrenzung werden bei postoperativen Patienten seltener und später getroffen als bei internistischen. Verschiedene Aspekte gehen in die End-of-Life-Entscheidung bei postoperativen Patienten ein: Das Selbstverständnis des Chirurgen, die Prognose des Patienten, die Art der Operation und die Ausbildung und Diskussionskultur bei ethischen Fragen in den verschiedenen medizinischen Fächern. Diese Motive und Überlegungen müssen bei der Initiierung einer End-of-Life-Diskussion bei postoperativen Patienten bedacht und berücksichtigt werden.

Wenn der Patient eines Internisten stirbt, fragen seine Kollegen: „Was ist passiert?“ Wenn der Patient eines Chirurgen stirbt, fragen seine Kollegen: „Was hast Du getan?“ (Charles Bosk [ 1])

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
eBook
USD 19.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Literatur

  1. Bosk CL. Forgive and remember: managing medical failure (2nd ed). Chicago, IL, University of Chicago Press; 1979

    Google Scholar 

  2. Buchman TG, Cassell J, Ray SE et al. Who should manage the dying patient? Rescue, shame, and the surgical ICU dilemma. J Am Coll Surg 2002; 194:665–673

    Article  PubMed  Google Scholar 

  3. Cassell J, Buchman TG, Streat S et al. Surgeons, intensivists, and the covenant of care: administrative models and values affecting care at the end of life - updated. Crit Care Med 2003; 31:1551–1559

    Article  PubMed  Google Scholar 

  4. Schwarze ML, Bradley CT, Brasel KJ. Surgical “buy-in”: the contractual relationship between surgeons and patients that influences decisions regarding life-supporting therapy. Crit Care Med 2010; 38:843–848

    Article  PubMed  Google Scholar 

  5. Barie PS, Bacchetta MD, Eachempati SR. The contemporary surgical intensive care unit. Structure, staffing, and issues. Surg Clin North Am 2000; 80:791–804

    Article  PubMed  CAS  Google Scholar 

  6. Kelley AS, Gold HT, Roach KW et al. Differential medical and surgical house staff involvement in end-of-life decisions: A retrospective chart review. J Pain Symptom Manage 2006; 32:110–117

    Article  PubMed  Google Scholar 

  7. Wunsch H, Harrison DA, Harvey S et al. End-of-life decisions: a cohort study of the withdrawal of all active treatment in intensive care units in the United Kingdom. Intensive Care Med 2005; 31:823–831

    Article  PubMed  Google Scholar 

  8. Bacchetta MD, Eachempati SR, Fins JJ et al. Factors influencing DNR decision-making in a surgical ICU. J Am Coll Surg 2006; 202:995–1000

    Article  PubMed  Google Scholar 

  9. Kazaure H, Roman S, Sosa JA. High mortality in surgical patients with do-not-resuscitate orders: analysis of 8256 patients. Arch Surg 2011;146:922–928

    Article  PubMed  Google Scholar 

  10. Speicher PJ, Lagoo-Deenadayalan SA, Galanos AN et al. Expectations and outcomes in geriatric patients with do-not-resuscitate orders undergoing emergency surgical management of bowel obstruction. JAMA Surg 2013; 148:23–28

    Article  PubMed  Google Scholar 

  11. Saager L, Kurz A, Deogaonkar A et al. Pre-existing do-not-resuscitate orders are not associated with increased postoperative morbidity at 30 days in surgical patients. Crit Care Med 2011; 39:1036–1041

    Article  PubMed  Google Scholar 

  12. Lissauer ME, Naranjo LS, Kirchoffner J et al. Patient characteristics associated with end-of-life decision making in critically ill surgical patients. J Am Coll Surg 2011; 213:766–770

    Article  PubMed  Google Scholar 

  13. Schwarze ML, Redmann AJ, Brasel KJ et al. The role of surgeon error in withdrawal of postoperative life support. Ann Surg 2012; 256:10–15

    Article  PubMed  Google Scholar 

  14. Paola F, Barten SS. An ’ethics gap’ in writing about bioethics: a quantitative comparison of the medical and the surgical literature. J Med Ethics 1995; 21:84–88

    Article  PubMed  CAS  Google Scholar 

  15. Rabow MW, Hardie GE, Fair JM et al. End-of-life care content in 50 textbooks from multiple specialties. JAMA 2000; 283:771–778

    Article  PubMed  CAS  Google Scholar 

  16. Becker G, Dausch V, Xander C et al. Palliativmedizinische Inhalte in deutschsprachigen medizinischen Lehrbüchern. Dtsch Med Wochenschr 2007; 132:256–260

    Article  PubMed  CAS  Google Scholar 

  17. Dunn GP, Milch RA. Introduction and historical background of palliative care: Where does the surgeon fit in? J Am Coll Surg 2001; 193:325–327

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Anästhesiologie und Intensivmedizin, Schwarzwald-Baar-Klinikum, Klinikstr. 11, 78052, Villingen-Schwenningen, Deutschland

    Prof. Dr. med. Albert Benzing

Authors
  1. Prof. Dr. med. Albert Benzing
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Albert Benzing .

Editor information

Editors and Affiliations

  1. Abt. für Anästh. u. Intensivmedizin, Waldburg-Zeil Klinik Tettnang, Tettnang, Germany

    Andrej Michalsen

  2. Klinik für Anästhesiologie und Intensivtherapie, Universitätsklinikum Jena, Jena, Germany

    Christiane S. Hartog

Rights and permissions

Reprints and permissions

Copyright information

© 2013 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Benzing, A. (2013). Therapiebegrenzung unter besonderen Umständen: Postoperative Phase. In: Michalsen, A., Hartog, C. (eds) End-of-Life Care in der Intensivmedizin. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-36944-5_12

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-36944-5_12

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-36943-8

  • Online ISBN: 978-3-642-36944-5

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation