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Med Intensiva. 2015 Oct;39(7):395-404. doi: 10.1016/j.medin.2014.06.005. Epub 2014 Sep 18.

Limitation of life-sustaining treatment in patients with prolonged admission to the ICU. Current situation in Spain as seen from the EPIPUSE Study.

[Article in English, Spanish]

Collaborators (95)

Saldaña González FJ, Galván Martín JM, Monterroso R, Rubio Quiñones J, Díaz Alersi R, Mayor García DM, Rodríguez Higueras I, Barranco Ruiz M, Sánchez Román JA, Suárez Pinilla MÁ, López Núñez C, García Ronquillo JC, Zamora Elson M, Torralba Allué JC, Tirado Anglés G, Poyo-Guerrero Lahoz R, Forteza Cañelas C, Santacreu R, Sisón Heredia M, Parrilla Toribio D, Rodríguez Ramos ST, Cordero Vallejo M, Castellanos Ortega Á, Bueno González A, Villegas del Ojo J, Benito Puncel C, Sánchez Rodríguez P, Sala Scarbay CJ, Loreto Álvarez Pérez T, Concepción Tarancón Maján F, González M, Cicuéndez Ávila R, Amador Amérigo J, Miró Andreu G, Mas A, Silva A, Zavala E, Rubio Sanchiz O, Basas M, León Vallés M, Iglesias Moles S, Ibáñez M, Cherta I, García Ramos MJ, Minaya González F, Gil Pérez NM, Gómez Canosa MS, Freita Ramos S, Astola Hidalgo I, Mourelo Fariña M, Saborido Paz E, Pereira Loureiro MÁ, García Martul M, Rodríguez Fernández MJ, Bravo Doviso JV, Martín Delgado MC, Estébanez Montiel MB, Gómez García JM, Arias Sarmiento E, Andino Ruiz R, Costas MG, Micharet AL, Honrubia Fernández T, Enciso Calderón MV, Hernández-Tejedor A, Díaz Díaz D, Hernández G, García de Lorenzo A, Gallardo Álvarez JA, Córdoba Sánchez ÁL, Cambronero Galache JA, Fernández Simón I, Valdivia de la Fuente M, Lacoma F, Prieto del Portillo I, López Martínez A, Herrera Para L, Salvador MA, Susarte Juliá CM, Martínez Martínez M, Monedero P, Barber Ansón M, Regidor Sanz E, Macaya Redín L, Domezain del Campo M, Manzano Ramírez A, Poveda Hernández Y, Castedo González JF, Mintegui Malcorra I, Elosegui Plaza I, Monzón Marín JL, Martínez Camarero L, Palomo Navarro M, Llamas Álvarez A, Kot P.

Author information

1
Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. Electronic address: albertohmed@hotmail.com.
2
Unidad de Cuidados Intensivos, Hospital Universitario de Torrejón, Torrejón de Ardoz, Madrid, España.
3
Unidad de Cuidados Intensivos, Hospital de Barcelona SCIAS, Barcelona, España.
4
Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España.

Abstract

OBJECTIVE:

Limitation of life-sustaining treatment (LLST) is a recommended practice in certain circumstances. Limitation practices are varied, and their application differs from one center to another. The present study evaluates the current situation of LLST practices in patients with prolonged admission to the ICU who suffer worsening of their condition.

DESIGN:

A prospective, observational cohort study was carried out.

SETTING:

Seventy-five Spanish ICUs.

PATIENTS:

A total of 589 patients suffering 777 complications or adverse events with organ function impairment after day 7 of admission, during a three-month recruitment period.

MAIN VARIABLES OF INTEREST:

The timing of limitation, the subject proposing LLST, the degree of agreement within the team, the influence of LLST upon the doctor-patient-family relationship, and the way in which LLST is implemented.

RESULTS:

LLST was proposed in 34.3% of the patients presenting prolonged admission to the ICU with severe complications. The incidence was higher in patients with moderate to severe lung disease, cancer, immunosuppressive treatment or dependence for basic activities of daily living. LLST was finally implemented in 97% of the cases in which it was proposed. The decision within the medical team was unanimous in 87.9% of the cases. The doctor-patient-family relationship usually does not change or even improves in this situation.

CONCLUSION:

LLST in ICUs is usually carried out under unanimous decision of the medical team, is performed more frequently in patients with severe comorbidity, and usually does not have a negative impact upon the relationship with the patients and their families.

KEYWORDS:

Bioethics; Bioética; Decision making; Decisiones al final de la vida; Life-sustaining treatment; Multiple organ dysfunction syndrome; Síndrome de disfunción multiorgánica; Tratamientos de soporte vital

PMID:
25241266
DOI:
10.1016/j.medin.2014.06.005
[Indexed for MEDLINE]
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