Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies

被引：0

作者：

Pasieka, Pawel ^{[1
]}

Surowka, Anna ^{[1
]}

Fronczek, Jakub ^{[1
]}

Skwara, Evan ^{[1
]}

Czuczwar, Miroslaw ^{[2
]}

Borys, Michal ^{[2
]}

Krawczyk, Pawel ^{[3
]}

Zietkiewicz, Miroslaw ^{[3
,4
]}

Nowak, Lukasz R. ^{[5
]}

Zukowski, Maciej ^{[6
]}

Kotfis, Katarzyna ^{[6
]}

Cwyl, Katarzyna ^{[7
]}

Skowronek, Jacek ^{[8
]}

Solek-Pastuszka, Joanna ^{[9
]}

Biernawska, Jowita ^{[9
]}

Grudzien, Pawel ^{[10
]}

Nasilowski, Pawel ^{[11
,12
]}

Popek, Natalia ^{[13
]}

Cyrankiewicz, Waldemar ^{[14
]}

Sierakowska, Katarzyna ^{[14
,15
]}

Mudyna, Wojciech ^{[16
]}

Bialka, Szymon ^{[17
]}

Studzinska, Dorota ^{[1
,18
]}

Bernas, Szymon ^{[19
]}

Piechota, Mariusz ^{[19
]}

Machala, Waldemar ^{[20
]}

Sadowski, Lukasz ^{[20
]}

Stefaniak, Jan ^{[21
]}

Owczuk, Radoslaw ^{[21
]}

Szymkowiak, Malgorzata ^{[22
]}

Gawda, Ryszard ^{[23
]}

Kozera, Natalia ^{[24
]}

Adamik, Barbara ^{[25
]}

Gozdzik, Waldemar ^{[25
]}

Wieczorek, Agnieszka ^{[26
]}

Janc, Jaroslaw ^{[26
]}

Kluzik, Anna ^{[27
,28
]}

Trzebicki, Janusz ^{[29
]}

Zatorski, Pawel ^{[29
]}

Gola, Wojciech ^{[30
]}

Hymczak, Hubert ^{[31
,32
]}

Krzych, Lukasz J. ^{[33
]}

Czajka, Szymon ^{[33
]}

Kosciuczuk, Urszula ^{[34
]}

Kudlinski, Bartosz ^{[35
]}

Flaatten, Hans ^{[36
]}

Szczeklik, Wojciech ^{[1
]}

机构：

[1] Jagiellonian Univ, Ctr Intens Care & Perioperat Med, Med Coll, Krakow, Poland

[2] Med Univ Lublin, Dept Anaesthesiol & Intens Care 2, Lublin, Poland

[3] Jagiellonian Univ, Med Coll, Dept Anaesthesiol & Intens Care Med, Krakow, Poland

[4] John Paul II Hosp Krakow, Dept Anaesthesiol & Intens Care 2, Krakow, Poland

[5] 5th Mil Clin Hosp Krakow, Dept Intens Care & Anaesthesiol, Krakow, Poland

[6] Pomeranian Med Univ, Dept Anaesthesiol Intens Therapy & Acute Intoxica, Szczecin, Poland

[7] Reg Hlth Ctr Lubin, Anesthes & Intens Care Unit, Lubin, Poland

[8] St Raphael Hosp, Dept Anaesthesiol & Intens Care, Krakow, Poland

[9] Pomeranian Med Univ SPSK 1, Dept Clin Anesthesiol & Intens Therapy PUM, Szczecin, Poland

[10] E Szczekl Specialist Hosp Tarnow, Dept Anaesthesiol & Intens Therapy, Tarnow, Poland

[11] G Narutowicz Specialist Hosp Krakow, Dept Anaesthesiol & Intens Therapy, Krakow, Poland

[12] St Ann Hosp Miechow, Dept Anaesthesiol & Intens Care, Miechow, Poland

[13] S Zeromski Specialist Hosp Krakow, Dept Anaesthesiol & Intens Therapy, Krakow, Poland

[14] Antoni Jurasz Univ Hosp 1, Dept Anaesthesiol & Intens Therapy, Bydgoszcz, Poland

[15] Nicolaus Copernicus Univ, Dept Anaesthesiol & Intens Therapy, Ludwik Rydygier Coll Med, Bydgoszcz, Poland

[16] Ludw Rydygier Mem Specialized Hosp Krakow, Dept Anaesthesiol & Intens Therapy, Krakow, Poland

[17] Med Univ Silesia, Sch Med, Dept Anaesthesiol & Crit Care, Div Dent Zabrze, Zabrze, Poland

[18] St John Grande Hosp Krakow, Dept Anaesthesiol & Intens Care, Krakow, Poland

[19] Dr Wl Bieganski Reg Specialist Hosp Lodz, Ctr Artificial Extracorporeal Kidney & Liver Supp, Dept Anaesthesiol & Intens Therapy, Lodz, Poland

[20] Med Univ Lodz, Dept Anaesthesiol & Intens Therapy, Cent Teaching Hosp, Lodz, Poland

[21] Med Univ Gdansk, Fac Med, Dept Anaesthesiol & Intens Therapy, Gdansk, Poland

[22] Prov Hosp Poznan, Dept Anaesthesiol & Intens Care, Poznan, Poland

[23] Univ Opole, Inst Med Sci, Dept Anesthesiol & Intens Care, Opole, Poland

[24] Wroclaw Med Univ, Dept Anaesthesiol & Intens Therapy, Wroclaw, Poland

[25] Wroclaw Med Univ, Dept Anesthesiol & Intens Therapy, Wroclaw, Poland

[26] 4th Mil Hosp Wroclaw, Anaesthes & Intens Care Unit, Wroclaw, Poland

[27] Poznan Univ Med Sci, Dept Anaesthesiol Intens Therapy & Pain Treatment, Poznan, Poland

[28] Poznan Univ Med Sci, Dept Teaching Anaesthesiol & Intens Therapy, Poznan, Poland

[29] Med Univ Warsaw, Univ Clin Ctr, Infant Jesus Clin Hosp, Dept Anaesthesiol & Intens Care 1, Warsaw, Poland

[30] Jan Kochanowski Univ, Fac Med & Hlth Sci, Kielce, Poland

[31] John Paul II Hosp Krakow, Dept Anaesthesiol & Intens Care 1, Krakow, Poland

[32] Andrzej Frycz Modrzewski Krakow Univ, Fac Med & Hlth Sci, Krakow, Poland

[33] Med Univ Silesia, Univ Clin Ctr, Sch Med Katowice, Dept Anaesthesiol & Intens Care, Katowice, Poland

[34] Med Unibers Bialystok, Dept Anaesthesiol & Intens Therapy, Bialystok, Poland

[35] Univ Hosp Zielona Gora, Clin Dept Anaesthesiol & Intens Care, Zielona Gora, Poland

[36] Haukeland Hosp, Dept Anaesthesia & Intens Care, Bergen, Norway

来源：

JOURNAL OF CRITICAL CARE | 2024年 / 79卷

关键词：

Intensive care; Futile therapy; Ethics; End-of-life care; Observational study; Geriatric population; Limitations of life-sustaining treatment; VIP study; END; ICU; DECISIONS; MORTALITY; UNITS;

D O I：

10.1016/j.jcrc.2023.154439

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Purpose: Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017.Methods: We analysed Polish cohorts from studies VIP1 (October 2016 -May 2017) and VIP2 (May 2018 -May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST.Results: 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001).Conclusions: The clinicians in Poland have become more proactive in limiting LST in critically ill patients >= 80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.

引用

页数：5

共 27 条

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