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Withholding or Withdrawing of Life-Sustaining Therapy in Older Adults (≥ 80 years) Admitted to the Intensive Care Unit

2018Journal article Open access
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dc.contributor.authorGuidet, B
dc.contributor.authorFlaatten, H
dc.contributor.authorBoumendil, A
dc.contributor.authorMorandi, A
dc.contributor.authorAndersen, FH
dc.contributor.authorArtigas, A
dc.contributor.authorBertolini, G
dc.contributor.authorCecconi, M
dc.contributor.authorChristensen, S
dc.contributor.authorFaraldi, L
dc.contributor.authorFjølner, J
dc.contributor.authorJung, C
dc.contributor.authorMarsh, B
dc.contributor.authorMoreno, R
dc.contributor.authorOeyen, S
dc.contributor.authorÖhman, C
dc.contributor.authorPinto, B
dc.contributor.authorSoliman, I
dc.contributor.authorSzczeklik, W
dc.contributor.authorValentin, A
dc.contributor.authorWatson, X
dc.contributor.authorZafeiridis, T
dc.contributor.authorDe Lange, D
dc.date.accessioned2019-10-29T16:38:21Z
dc.date.available2019-10-29T16:38:21Z
dc.date.issued2018
dc.description.abstractPURPOSE: 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).pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationIntensive Care Med. 2018 Jul;44(7):1027-1038.pt_PT
dc.identifier.doi10.1007/s00134-018-5196-7pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3344
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherSpringerpt_PT
dc.subjectAged, 80 and overpt_PT
dc.subjectDecision Makingpt_PT
dc.subjectEuropept_PT
dc.subjectHumanspt_PT
dc.subjectIntensive Care Unitspt_PT
dc.subjectMalept_PT
dc.subjectProspective Studiespt_PT
dc.subjectLife Support Carept_PT
dc.subjectWithholding Treatmentpt_PT
dc.subjectHSJ UCIpt_PT
dc.titleWithholding or Withdrawing of Life-Sustaining Therapy in Older Adults (≥ 80 years) Admitted to the Intensive Care Unitpt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1038pt_PT
oaire.citation.issue7pt_PT
oaire.citation.startPage1027pt_PT
oaire.citation.titleIntensive Care Medicinept_PT
oaire.citation.volume44pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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