Limitation of life support techniques at admission to the intensive care unit : A multicenter prospective cohort study
Rubio, Olga (Hospital Sant Joan De Déu)
Arnau, Anna (Hospital Sant Joan De Déu)
Cano, Silvia (Hospital Sant Joan De Déu)
Subirà, Carles (Hospital Sant Joan De Déu)
Balerdi, Begoña (Hospital Universitari i Politècnic La Fe (València))
Perea, María Eugenía (Hospital General Yagüe (Burgos))
Fernández-Vivas, Miguel (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Barber, María (Complejo Hospitalario de Navarra)
Llamas, Noemí (Hospital Morales Messeguer)
Altaba, Susana (Hospital Universitario de Castellon)
Prieto, Ana (Hospital Rio Hortega)
Gómez, Vicente (Hospital la Moncloa)
Martin, Mar (Hospital Universitario Nuestra Señora de Candelaria (Santa Cruz de Tenerife))
Paz, Marta (Hospital Clínico Universitario (Salamanca))
Quesada, Belen (Hospital Universitario Fundación Jiménez Díaz)
Español, Valentí (Hospital Universitario Central de Asturias)
Montejo, Juan Carlos (Hospital 12 de Octubre (Madrid))
Gomez, José Manuel (Hospital General Universitario Gregorio Marañón)
Miro, Gloria (Hospital Mataro)
Xirgú, Judith (Hospital General de Granollers)
Ortega Montes, Ana (Hospital Montecelo Pontevedra)
Rascado, Pedro (Centro Hospitalario Universitario Santiago Compostela)
Sánchez, Juan María (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Marcos, Alfredo (Hospital Virgen de la Concha (Zamora))
Tizon, Ana (Hospital Xeral Cíes Vigo)
Monedero, Pablo (Clínica Universidad de Navarra)
Zabala, Elisabeth (Hospital Clínic i Provincial de Barcelona)
Murcia, Cristina (Hospital Universitari de Girona Doctor Josep Trueta)
Torrejon, Ines (Hospital de Henares)
Planas, Kenneth (Hospital Moisses Broggi)
Añón, José Manuel (Hospital Virgen de La Luz (Cuenca))
Hernandez, Gonzalo (Hospital Universitario Infanta Sofía (San Sebastián de los Reyes))
Fernandez, María-del-Mar. (Hospital Universitari MútuaTerrassa)
Guía, Consuelo (Parc Taulí Hospital Universitari. Institut d'Investigació i Innovació Parc Taulí (I3PT))
Arauzo, Vanesa (Hospital Universitari MútuaTerrassa (Terrassa, Catalunya))
Perez, José Miguel (Hospital Universitario Virgen de las Nieves (Granada))
Catalan, Rosa (Hospital General de Vic)
Gonzalez, Javier (Hospital Virgen Vega Salamanca)
Poyo, Rosa (Hospital Universitari Son Llàtzer (Palma de Mallorca, Balears))
Tomas, Roser (Hospital General de Catalunya)
Saralegui, Iñaki (Hospital de Áraba)
Mancebo, Jordi (Institut d'Investigació Biomèdica Sant Pau)
Sprung, Charles (Hadassh Hebrew University Medical Center)
Fernández, Rafael (Fundació Althaia Xarxa Universitaria de Manresa)
Universitat Autònoma de Barcelona

Date:	2018
Abstract:	To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. We recruited 3042 patients (age 62. 5 ± 16. 1 years). Most ICUs (94. 8%) admitted patients with LLST, but only 238 (7. 8% [95% CI 7. 0-8. 8]) patients had LLST on ICU admission; this group had higher ICU mortality (44. 5 vs. 9. 4% in patients without LLST; p < 0. 001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2. 30 [95% CI 1. 59-2. 96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31. 7-44. 5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Critical care ; Intensive care units ; Limitations on life support techniques ; Palliative care
Published in:	Journal of Intensive Care, Vol. 6 Núm. 1 (13 2018) , p. 24, ISSN 2052-0492

DOI: 10.1186/s40560-018-0283-y
PMID: 29686878

9 p, 464.1 KB

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Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Parc Taulí Research and Innovation Institute (I3PT
Research literature > UAB research groups literature > Research Centres and Groups (research output) > Health sciences and biosciences > Institut de Recerca Sant Pau
Articles > Research articles
Articles > Published articles