Changes in limitations of life-sustaining treatments over time in a French intensive care unit: A prospective observational study.
J Crit Care
; 47: 21-29, 2018 10.
Article
em En
| MEDLINE
| ID: mdl-29886063
ABSTRACT
BACKGROUND:
Variability exists between ICUs in the limitations of therapy. Moreover practices may evolve over time. This single-center observational study aimed to compare withholding or withdrawing practices between 2012 and 2016.METHODS:
For each period and patient concerned by limitations, withholding "do-not start", withholding "do-not-increase" and withdrawal measures were recorded.RESULTS:
At a four-year interval, the rate of patients undergoing withholding or withdrawal rose from 10 to 23% and 4 to 7%, respectively. The proportion of patients dying in the ICU with previous limitations increased (53 to 89%), as did patients discharged alive despite withholding instructions (12 to 36%). The overall mortality (28%) was stable over time as the rate of failed resuscitation attempt declined (47 to 11%). In 2016 vs 2012, limitations started earlier following admission 1 vs 7â¯days for withholding" do-not-start", 4 vs 8 for withholding "do-not-increase", 4 vs 7 for withdrawal. Notwithstanding the outcome and limitations applied, the median length of ICU stay of patients involved dropped from 13â¯days in 2012 to 8â¯days in 2016.CONCLUSION:
A timely inclination to forego hopeless treatments resulted in a lower rate of failed resuscitations before death without change in global mortality.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Ressuscitação
/
Avaliação de Resultados em Cuidados de Saúde
/
Estado Terminal
/
Suspensão de Tratamento
/
Tomada de Decisões
/
Tempo de Internação
País/Região como assunto:
Europa
Idioma:
En
Ano de publicação:
2018
Tipo de documento:
Article