Collaboration between intensive care unit physicians and physiatrists with severe brain injured patients: A French practice survey

Abstract

The role of physiatrists with severe brain injured patients and intensive care unit (ICU) teams is often pointed out but remains still partly unknown. We aimed at evaluating, from ICU physicians and physiatrists’ points of view, the characteristics of interventions of physiatrists in ICU (especially concerning end-of-life decisions) and their possibilities of development. A national study using an online survey was performed between January and September 2017, sent to ICU physicians (n = 181 answers) and physiatrists (n = 35) dealing with severe brain injured patients. A large majority of ICU physicians (72%) collaborated with physiatrists in their practice, most often non-routinely (78%) on a weekly (30.5%) or monthly basis (36.6%). Physiatrists mainly helped ICU teams in post-ICU orientation of patients (85%), but also in clinical assessment (55%). Considering end-of-life decisions, solicitations of physiatrists were rare in the ICU physicians’ point of view (47% on an annual basis), but more frequent in the physiatrists sample (monthly or bimonthly = 48%), and was considered as beneficial or necessary for 70% of ICU physicians. Physiatrists and ICU physicians gave the same importance in the end-of-life decision process to clinical and paraclinical examinations, but not to patients socio-economic data. Physiatrists mainly conceived their interventions in end-of-life decisions in complex cases (56%), their legitimacy in this domain was rated as 6.5/10 (10 = high legitimacy) by ICU physicians. Improving the collaboration between both specialties was a common desire (of 68% of physiatrists and 88% of ICU physicians). Physiatrists have a specific and important role to play with severe brain injured patients in ICU, in various domains of action including particularly orientation, assessment or end-of-life decision process. This role should be promoted and better valorized.