6533b7d0fe1ef96bd125adb3
RESEARCH PRODUCT
Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit
Guidet B.Flaatten H.Boumendil A.Morandi A.Andersen F. H.Artigas A.Bertolini G.Cecconi M.Christensen S.Faraldi L.Fjolner J.Jung C.Marsh B.Moreno R.Oeyen S.Ohman C. A.Pinto B. B.Soliman I. W.Szczeklik W.Valentin A.Watson X.Zafeiridis T.De Lange D. W.Schmutz R.Wimmer F.Eller P.Zotter K.De Buysscher P.De Neve N.Oeyen S.Swinnen W.Pinto B. B.Abraham P.Hergafi L.Schefold J. C.Biskup E.Taliadoros I.Piza P.Lauten A.Sacher A. L.Brenner T.Franz M.Bloos F.Ebelt H.Schaller S. J.Fuest K.Rabe C.Dieck T.Steiner S.Graf T.Nia A. M.Jung C.Janosi R. A.Simon P.Utzolino S.Rahmel T.Barth E.Jung C.Schuster M.Fjolner J.Dey N.Solling C.Rasmussen B. S.Christensen S.Rodriguez E.Rebollo S.Aguilar G.Masdeu G.Jaimes M. I.Mira A. P.Bodi M. A.Barea Mendoza J. A.Lopez-cuenca S.Guzman M. H.Rico-feijoo J.Ibarz M.Alvarez J. T.Forceville X.Besch G.Mentec H.Michel P.Mateu P.Michel P.Vettoretti L.Bourenne J.Marin N.Guillot M.Aissaoui N.Goulenok C.Thieulot-rolin N.Messika J.Lamhaut L.Guidet B.Charron C.Dempsey G.Mathew S. J.Raj A. S.Grecu I.Cupitt J.Lawton T.Clark R.Popescu M.Spittle N.Faulkner M.Cowton A.Elloway E.Williams P.Reay M.Chukkambotla S.Kumar R.Al-subaie N.Kent L.Tamm T.Kajtor I.Burns K.Pugh R.Ostermann M.Kam E.Bowyer H.Smith N.Templeton M.Henning J.Goffin K.Kapoor R.Laha S.Chilton P.Khaliq W.Crayford A.Coetzee S.Tait M.Stoker W.Gimenez M.Pope A.Camsooksai J.Pogson D.Quigley K.Ritzema J.Hormis A.Boulanger C.Balasubramaniam M.Vamplew L.Burt K.Martin D.Grecu I.Craig J.Prowle J.Doyle N.Shelton J.Scott C.Donnison P.Shelton S.Frey C.Ryan C.Spray D.Ryan C.Barnes V.Barnes K.Ridgway S.Saha R.Kent L.Clark T.Wood J.Bolger C.Bassford C.Cowton A.Lewandowski J.Zhao X.Humphreys S.Dowling S.Richardson N.Burtenshaw A.Stevenson C.Wilcock D.Aidoni Z.Aloizos S.Tasioudis P.Lampiri K.Zisopoulou V.Ravani I.Pagaki E.Antoniou A.Katsoulas T. A.Kounougeri A.Marinakis G.Tsimpoukas F.Spyropoulou A.Zygoulis P.Kyparissi A.Hayes I.Marsh B.Kelly Y.Westbrook A.Fitzpatrick G.Maheshwari D.Motherway C.Gupta M.Gurjar M.Maji I. M.Negri G.Spadaro S.Nattino G.Pedeferri M.Boscolo A.Rossi S.Calicchio G.Cubattoli L.Di Lascio G.Barbagallo M.Berruto F.Codazzi D.Bottazzi A.Fumagalli P.Negro G.Lupi G.Savelli F.Vulcano G. A.Fumagalli R.Marudi A.Lefons U.Lembo R.Babini M.Paggioro A.Parrini V.Zaccaria M.Clementi S.Gigliuto C.Facondini F.Pastorini S.Munaron S.Calamai I.Bocchi A.Adorni A.Bocci M. G.Cortegiani A.Casalicchio T.Mellea S.Graziani E.Barattini M.Brizio E.Rossi M.Van Dijk I.Van Lelyveld-haas L. E. M.Ramnarain D.Jansen T.Nooteboom F.Van Der Voort P. H.De Lange D.Dieperink W.De Waard M. C.De Smet A. G. E.Bormans L.Dormans T.Hahn M.Flaatten H.Kemmerer N.Strietzel H. F.Dybwik K.Legernaes T.Klepstad P.Olaussen E. B.Olsen K. I.Brresen O. M.Bjorsvik G.Andersen F. H.Maini S.Fehrle L.Czuczwar M.Krawczyk P.Zietkiewicz M.Nowak L. R.Kotfis K.Cwyl K.Gajdosz R.Biernawska J.Bohatyrewicz R.Gawda R.Grudzien P.Nasilowski P.Popek N.Cyrankiewicz W.Wawrzyniak K.Wnuk M.Maciejewski D.Studzinska D.Zukowski M.Bernas S.Piechota M.Szczeklik W.Nowak I.Fronczek J.Serwa M.Machala W.Stefaniak J.Wujtewicz M.Maciejewski P.Szymkowiak M.Adamik B.Catorze N.Branco M. C.Barros I.Barros N.Krystopchuk A.Honrado T.Sousa C.Munoz F.Rebelo M.Gomes R.Nunes J.Dias C.Fernandes A. M.Petrisor C.Constantin B.Belskiy V.Boskholov B.Kawati R.Sivik J.Nauska J.Smole D.Parenmark F.Lyren J.Rockstroh K.Ryden S.Spangfors M.Strinnholm M.Walther S.De Geer L.Nordlund P.Palsson S.Zetterquist H.Nilsson A.Thiringer K.Jungner M.Bark B.Nordling B.Skold H.Brorsson C.Persson S.Bergstrom A.Berkius J.Holmstrom J.Nalapko Y.subject
Malemedicine.medical_treatmentHSJ UCICritical Care and Intensive Care Medicinelaw.inventionLife sustaining treatment0302 clinical medicineElderlylaw80 and overMedicine030212 general & internal medicineProspective StudiesProspective cohort studyAged 80 and overeducation.field_of_studyWithholding Treatmentddc:617[SDV.MHEP.GEG]Life Sciences [q-bio]/Human health and pathology/Geriatry and gerontologyWithholdingIntensive care unit3. Good healthEuropeagedIntensive Care UnitsWithdrawalSOFA scoreHumanmedicine.medical_specialtyethical aspectsPopulationIntensive Care UnitDecision MakingElderly; Ethics; Intensive care; Life sustaining treatment; Withdrawal; Withholding;life-sustaining therapyNO03 medical and health sciencesIntensive careAnesthesiologyHumansEthiceducationMechanical ventilationEthicsbusiness.industry030208 emergency & critical care medicineElderly; Ethics; Intensive care; Life sustaining treatment; Withdrawal; Withholdingcritical careLife Support CareProspective StudieWithholding TreatmentIntensive careEmergency medicineElderly; Ethics; Intensive care; Life sustaining treatment; Withdrawal; Withholding; Aged 80 and over; Decision Making; Europe; Humans; Intensive Care Units; Male; Prospective Studies; Life Support Care; Withholding Treatmentbusinessdescription
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). info:eu-repo/semantics/publishedVersion
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2018-07-01 |