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Med Intensiva. 2019 Aug - Sep;43(6):352-361. doi: 10.1016/j.medin.2018.03.010. Epub 2018 May 7.

Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study.

[Article in English, Spanish]

Author information

1
Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain.
2
Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain.
3
Transplant Coordination, University Hospital Vall d'Hebron, Barcelona, Spain.
4
Transplant Coordination, University Hospital Bellvitge, Barcelona, Spain.
5
Intensive Care Unit, University Hospital Moises Broggi, Barcelona, Spain.
6
Intensive Care Unit, University Hospital Verge de la Cinta de Tortosa, Tortosa, Spain.
7
Intensive Care Unit, Consorci Sanitari del Maresme, Mataró, Spain.
8
Intensive Care Unit, University Hospital Mutua de Terrassa, Terrassa, Spain.
9
Intensive Care Unit, University Hospital Arnau de Vilanova, Lleida, Spain.
10
Intensive Care Unit, University Hospital General de Catalunya, Barcelona, Spain.
11
Intensive Care Unit, Hospital de Terrassa, Terrassa, Spain.
12
Intensive Care Unit, University Hospital de Vic, Vic, Spain.
13
International University of Catalunya, Barcelona, Spain.
14
Transplant Coordination, University Hospital Dr. Trueta, Girona, Spain.
15
Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, University Rovira i Virgili, CIBERES, Tarragona, Spain. Electronic address: mbodi.hj23.ics@gencat.cat.

Abstract

OBJECTIVE:

To determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission.

STUDY DESIGN:

Prospective multicenter study.

SETTING:

Eleven ICUs.

PATIENTS:

All patients who died and/or had limitations on life support after ICU admission during a four-month period.

VARIABLES:

Patient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early (<48h of admission) or late (≥48h). We performed univariate, multivariate analyses and CHAID (chi-square automatic interaction detection) analysis of variables associated with limitation of life support within 48h of ICU admission.

RESULTS:

3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%-84.2%). The median (p25-p75) time from admission to initial limitation was 2 (0-7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR=2.5; 95% CI: 1.5-4.4) and lung disease was the variable most strongly associated with early limitations (OR=12.29; 95% CI: 1.63-255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR=2.4; 95% CI: 1.1-5.5).

CONCLUSION:

Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48h of admission.

KEYWORDS:

Decisiones al final de la vida; End-of-life decisions; Intensive care unit; Life-support treatment limitation; Limitación del tratamiento de soporte vital; Unidad de Cuidados Intensivos; Withdrawing; Withholding

PMID:
29747939
DOI:
10.1016/j.medin.2018.03.010
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