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

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. This prospective study included intensive care patients aged 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. LST lim...

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Autores: Guidet, B, Flaatten, H, Boumendil, A, Morandi, A, Andersen, FH, Artigas, A, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjolner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Ohman, CA, Pinto, BB, Soliman, IW, Szczeklik, W, Valentin, A, Watson, X, Zafeiridis, T, De Lange, DW
Formato: artículo
Estado:Versión publicada
Fecha de publicación:2018
País:España
Recursos:Institut d'Investigació i Innovació Parc Taulí (I3PT)
Repositorio:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
OAI Identifier:oai:i3pt.fundanetsuite.com:p3999
Acesso em linha:https://i3pt.portalinvestigacion.com/publicaciones/3999
Access Level:acceso abierto
Palavra-chave:Elderly
Intensive care
Ethics
Life sustaining treatment
Withholding
Withdrawal
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spelling Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unitGuidet, BFlaatten, HBoumendil, AMorandi, AAndersen, FHArtigas, ABertolini, GCecconi, MChristensen, SFaraldi, LFjolner, JJung, CMarsh, BMoreno, ROeyen, SOhman, CAPinto, BBSoliman, IWSzczeklik, WValentin, AWatson, XZafeiridis, TDe Lange, DWElderlyIntensive careEthicsLife sustaining treatmentWithholdingWithdrawalTo document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. This prospective study included intensive care patients aged 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. 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. The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. ClinicalTrials.gov (ID: NTC03134807).SPRINGER2018info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionhttps://i3pt.portalinvestigacion.com/publicaciones/3999INTENSIVE CARE MEDICINEISSN: 03424642ISSNe: 14321238reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulíinstname:Institut d'Investigació i Innovació Parc Taulí (I3PT)Inglésinfo:eu-repo/semantics/openAccessoai:i3pt.fundanetsuite.com:p39992026-06-21T15:30:37Z
dc.title.none.fl_str_mv Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
title Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
spellingShingle Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
Guidet, B
Elderly
Intensive care
Ethics
Life sustaining treatment
Withholding
Withdrawal
title_short Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
title_full Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
title_fullStr Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
title_full_unstemmed Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
title_sort Withholding or withdrawing of life-sustaining therapy in older adults (>= 80 years) admitted to the intensive care unit
dc.creator.none.fl_str_mv Guidet, B
Flaatten, H
Boumendil, A
Morandi, A
Andersen, FH
Artigas, A
Bertolini, G
Cecconi, M
Christensen, S
Faraldi, L
Fjolner, J
Jung, C
Marsh, B
Moreno, R
Oeyen, S
Ohman, CA
Pinto, BB
Soliman, IW
Szczeklik, W
Valentin, A
Watson, X
Zafeiridis, T
De Lange, DW
author Guidet, B
author_facet Guidet, B
Flaatten, H
Boumendil, A
Morandi, A
Andersen, FH
Artigas, A
Bertolini, G
Cecconi, M
Christensen, S
Faraldi, L
Fjolner, J
Jung, C
Marsh, B
Moreno, R
Oeyen, S
Ohman, CA
Pinto, BB
Soliman, IW
Szczeklik, W
Valentin, A
Watson, X
Zafeiridis, T
De Lange, DW
author_role author
author2 Flaatten, H
Boumendil, A
Morandi, A
Andersen, FH
Artigas, A
Bertolini, G
Cecconi, M
Christensen, S
Faraldi, L
Fjolner, J
Jung, C
Marsh, B
Moreno, R
Oeyen, S
Ohman, CA
Pinto, BB
Soliman, IW
Szczeklik, W
Valentin, A
Watson, X
Zafeiridis, T
De Lange, DW
author2_role author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
author
dc.subject.none.fl_str_mv Elderly
Intensive care
Ethics
Life sustaining treatment
Withholding
Withdrawal
topic Elderly
Intensive care
Ethics
Life sustaining treatment
Withholding
Withdrawal
description 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. This prospective study included intensive care patients aged 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. 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. The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. ClinicalTrials.gov (ID: NTC03134807).
publishDate 2018
dc.date.none.fl_str_mv 2018
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://i3pt.portalinvestigacion.com/publicaciones/3999
url https://i3pt.portalinvestigacion.com/publicaciones/3999
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.rights.none.fl_str_mv info:eu-repo/semantics/openAccess
eu_rights_str_mv openAccess
dc.publisher.none.fl_str_mv SPRINGER
publisher.none.fl_str_mv SPRINGER
dc.source.none.fl_str_mv INTENSIVE CARE MEDICINE
ISSN: 03424642
ISSNe: 14321238
reponame:r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
instname:Institut d'Investigació i Innovació Parc Taulí (I3PT)
instname_str Institut d'Investigació i Innovació Parc Taulí (I3PT)
reponame_str r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
collection r-I3PT. Repositorio Institucional Producción Científica del Institut d'Investigació i Innovació Parc Taulí
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15,228081

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