Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit.
- Guidet B Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. bertrand.guidet@aphp.fr.
- Flaatten H Department of Clinical Medicine, University of Bergen, Bergen, Norway.
- Boumendil A Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. ariane.boumendil@gmail.com.
- Morandi A Department of Rehabilitation, Hospital Ancelle di Cremona, Cremona, Italy.
- Andersen FH Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
- Artigas A Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
- Bertolini G Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipartimento di Salute Pubblica, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Villa Camozzi, 24020, Ranica, Bergamo, Italy.
- Cecconi M St George's University Hospital, London, UK.
- Christensen S Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Åarhus, Denmark.
- Faraldi L Grande Ospedale Metropolitano Niguarda, Milan, Italy.
- Fjølner J Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Åarhus, Denmark.
- Jung C Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
- Marsh B Mater Misericordiae University Hospital, Dublin, Ireland.
- Moreno R Unidade de Cuidados Intensivos Polivalente Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School, Lisbon, Portugal.
- Oeyen S Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
- Öhman CA Karolinska University Hospital, Solna, Sweden.
- Pinto BB Geneva University Hospitals, Geneva, Switzerland.
- Soliman IW Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.
- Szczeklik W Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland.
- Valentin A Kardinal Schwarzenberg Hospital, Schwarzach, Austria.
- Watson X St George's University Hospital, London, UK.
- Zafeiridis T Intensive Care Unit General Hospital of Larissa, Larissa, Greece.
- De Lange DW Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.
- 2018-05-19
Published in:
- Intensive care medicine. - 2018
Elderly
Ethics
Intensive care
Life sustaining treatment
Withdrawal
Withholding
Aged, 80 and over
Decision Making
Europe
Humans
Intensive Care Units
Life Support Care
Male
Prospective Studies
Withholding Treatment
English
PURPOSE
To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.
METHODS
This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.
RESULTS
LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.
CONCLUSIONS
The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.
TRIAL REGISTRATION
ClinicalTrials.gov (ID: NTC03134807).
To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.
METHODS
This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.
RESULTS
LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.
CONCLUSIONS
The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.
TRIAL REGISTRATION
ClinicalTrials.gov (ID: NTC03134807).
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1007/s00134-018-5196-7
- PMID 29774388
- Persistent URL
- https://sonar.ch/global/documents/69985
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