Format

Send to

Choose Destination
Intensive Care Med. 2018 Jul;44(7):1027-1038. doi: 10.1007/s00134-018-5196-7. Epub 2018 May 17.

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

Collaborators (318)

Schmutz R, Wimmer F, Eller P, Zotter K, De Buysscher P, De Neve N, Oeyen S, Swinnen W, Pinto BB, Abraham P, Hergafi L, Schefold JC, Biskup E, Taliadoros I, Piza P, Lauten A, Sacher AL, Brenner T, Franz M, Bloos F, Ebelt H, Schaller SJ, Fuest K, Rabe C, Dieck T, Steiner S, Graf T, Nia AM, Jung C, Janosi RA, Simon P, Utzolino S, Rahmel T, Barth E, Jung C, Schuster M, Fjølner J, Dey N, Sølling C, Rasmussen BS, Christensen S, Rodriguez E, Rebollo S, Aguilar G, Masdeu G, Jaimes MI, Mira ÁP, Bodi MA, Barea Mendoza JA, López-Cuenca S, Guzman MH, Rico-Feijoo J, Ibarz M, Alvarez JT, Forceville X, Besch G, Mentec H, Michel P, Mateu P, Michel P, Vettoretti L, Bourenne J, Marin N, Guillot M, Aissaoui N, Goulenok C, Thieulot-Rolin N, Messika J, Lamhaut L, Guidet B, Charron C, Dempsey G, Mathew SJ, Raj AS, Grecu I, Cupitt J, Lawton T, Clark R, Popescu M, Spittle N, Faulkner M, Cowton A, Elloway E, Williams P, Reay M, Chukkambotla S, Kumar R, Al-Subaie N, Kent L, Tamm T, Kajtor I, Burns K, Pugh R, Ostermann M, Kam E, Bowyer H, Smith N, Templeton M, Henning J, Goffin K, Kapoor R, Laha S, Chilton P, Khaliq W, Crayford A, Coetzee S, Tait M, Stoker W, Gimenez M, Pope A, Camsooksai J, Pogson D, Quigley K, Ritzema J, Hormis A, Boulanger C, Balasubramaniam M, Vamplew L, Burt K, Martin D, Grecu I, Craig J, Prowle J, Doyle N, Shelton J, Scott C, Donnison P, Shelton S, Frey C, Ryan C, Spray D, Ryan C, Barnes V, Barnes K, Ridgway S, Saha R, Kent L, Clark T, Wood J, Bolger C, Bassford C, Cowton A, Lewandowski J, Zhao X, Humphreys S, Dowling S, Richardson N, Burtenshaw A, Stevenson C, Wilcock D, Aidoni Z, Aloizos S, Tasioudis P, Lampiri K, Zisopoulou V, Ravani I, Pagaki E, Antoniou A, Katsoulas TA, Kounougeri A, Marinakis G, Tsimpoukas F, Spyropoulou A, Zygoulis P, Kyparissi A, Hayes I, Marsh B, Kelly Y, Westbrook A, Fitzpatrick G, Maheshwari D, Motherway C, Gupta M, Gurjar M, Maji IM, Negri G, Spadaro S, Nattino G, Pedeferri M, Boscolo A, Rossi S, Calicchio G, Cubattoli L, Di Lascio G, Barbagallo M, Berruto F, Codazzi D, Bottazzi A, Fumagalli P, Negro G, Lupi G, Savelli F, Vulcano GA, Fumagalli R, Marudi A, Lefons U, Lembo R, Babini M, Paggioro A, Parrini V, Zaccaria M, Clementi S, Gigliuto C, Facondini F, Pastorini S, Munaron S, Calamai I, Bocchi A, Adorni A, Bocci MG, Cortegiani A, Casalicchio T, Mellea S, Graziani E, Barattini M, Brizio E, Rossi M, van Dijk I, van Lelyveld-Haas LEM, Ramnarain D, Jansen T, Nooteboom F, van der Voort PH, de Lange D, Dieperink W, de Waard MC, de Smet AGE, Bormans L, Dormans T, Hahn M, Flaatten H, Kemmerer N, Strietzel HF, Dybwik K, Legernaes T, Klepstad P, Olaussen EB, Olsen KI, Brresen OM, Bjorsvik G, Andersen FH, Maini S, Fehrle L, Czuczwar M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Kotfis K, Cwyl K, Gajdosz R, Biernawska J, Bohatyrewicz R, Gawda R, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Wawrzyniak K, Wnuk M, Maciejewski D, Studzińska D, Żukowski M, Bernas S, Piechota M, Szczeklik W, Nowak I, Fronczek J, Serwa M, Machała W, Stefaniak J, Wujtewicz M, Maciejewski P, Szymkowiak M, Adamik B, Catorze N, Branco MC, Barros I, Barros N, Krystopchuk A, Honrado T, Sousa C, Munoz F, Rebelo M, Gomes R, Nunes J, Dias C, Fernandes AM, Petrisor C, Constantin B, Belskiy V, Boskholov B, Kawati R, Sivik J, Nauska J, Smole D, Parenmark F, Lyrén J, Rockstroh K, Rydén S, Spångfors M, Strinnholm M, Walther S, De Geer L, Nordlund P, Pålsson S, Zetterquist H, Nilsson A, Thiringer K, Jungner M, Bark B, Nordling B, Sköld H, Brorsson C, Persson S, Bergström A, Berkius J, Holmström J, Nalapko Y.

Author information

1
Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. bertrand.guidet@aphp.fr.
2
Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, 75013, Paris, France. bertrand.guidet@aphp.fr.
3
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
4
Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway.
5
Hôpitaux de Paris, Hôpital Saint-Antoine, service de réanimation médicale, 184 rue du Faubourg Saint Antoine, 75012, Paris, France. ariane.boumendil@gmail.com.
6
Department of Rehabilitation, Hospital Ancelle di Cremona, Cremona, Italy.
7
Geriatric Research Group, Brescia, Italy.
8
Department of Anaesthesia and Intensive Care, Ålesund Hospital, Ålesund, Norway.
9
Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.
10
Department of Intensive Care Medicine, CIBER Enfermedades Respiratorias, Corporacion Sanitaria Universitaria Parc Tauli, Autonomous University of Barcelona, Sabadell, Spain.
11
Laboratorio di Epidemiologia Clinica, Centro di Coordinamento GiViTI Dipartimento di Salute Pubblica, IRCCS - Istituto di Ricerche Farmacologiche "Mario Negri" Villa Camozzi, 24020, Ranica, Bergamo, Italy.
12
St George's University Hospital, London, UK.
13
Department of Anaesthesia and Intensive Care Medicine, Aarhus University Hospital, Åarhus, Denmark.
14
Grande Ospedale Metropolitano Niguarda, Milan, Italy.
15
Department of Cardiology, Pulmonology and Angiology, University Hospital, Düsseldorf, Germany.
16
Mater Misericordiae University Hospital, Dublin, Ireland.
17
Unidade de Cuidados Intensivos Polivalente Neurocríticos, Hospital de São José, Centro Hospitalar de Lisboa Central, Faculdade de Ciência Médicas de Lisboa, Nova Médical School, Lisbon, Portugal.
18
Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium.
19
Karolinska University Hospital, Solna, Sweden.
20
Geneva University Hospitals, Geneva, Switzerland.
21
Department of Intensive Care, University Medical Center, University Utrecht, Utrecht, The Netherlands.
22
Intensive Care and Perioperative Medicine Division, Jagiellonian University Medical College, Kraków, Poland.
23
Kardinal Schwarzenberg Hospital, Schwarzach, Austria.
24
Intensive Care Unit General Hospital of Larissa, Larissa, Greece.

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 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).

KEYWORDS:

Elderly; Ethics; Intensive care; Life sustaining treatment; Withdrawal; Withholding

PMID:
29774388
DOI:
10.1007/s00134-018-5196-7
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Springer
Loading ...
Support Center