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Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

Guidet, Bertrand ; Flaatten, Hans ; Boumendil, Ariane ; Morandi, Alessandro ; Andersen, Finn H ; Artigas, Antonio ; Bertolini, Guido ; Cecconi, Maurizio ; Christensen, Steffen and Faraldi, Loredana , et al. (2018) In Intensive Care Medicine 44(7). p.1027-1038
Abstract

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... (More)

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).

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@article{c67c3bbf-4199-4e27-a481-d31d811dbadb,
  abstract     = {<p>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.</p><p>METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.</p><p>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.</p><p>CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.</p><p>TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807).</p>},
  author       = {Guidet, Bertrand and Flaatten, Hans and Boumendil, Ariane and Morandi, Alessandro and Andersen, Finn H and Artigas, Antonio and Bertolini, Guido and Cecconi, Maurizio and Christensen, Steffen and Faraldi, Loredana and Fjølner, Jesper and Jung, Christian and Marsh, Brian and Moreno, Rui and Oeyen, Sandra and Öhman, Christina Agwald and Pinto, Bernardo Bollen and Soliman, Ivo W and Szczeklik, Wojciech and Valentin, Andreas and Watson, Ximena and Zafeiridis, Tilemachos and De Lange, Dylan W},
  issn         = {0342-4642},
  language     = {eng},
  number       = {7},
  pages        = {1027--1038},
  publisher    = {Springer},
  series       = {Intensive Care Medicine},
  title        = {Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit},
  url          = {http://dx.doi.org/10.1007/s00134-018-5196-7},
  doi          = {10.1007/s00134-018-5196-7},
  volume       = {44},
  year         = {2018},
}