Life-sustaining treatment limitation criteria upon admission to the intensive care unit: results of a Spanish national multicenter survey

Objective: To determine the life-sustaining treatment limitation (LSTL) predisposition upon patient admission to the intensive care unit (ICU), the criteria upon which such predisposition is based, and whether these decisions are related to structural factors of the surveyed hospitals. Design: A descriptive multicenter study was made in 2010, involving the conduction of a survey in 90 hospitals, with a view to documenting the usual practice referred to LSTL upon admission in these centers. Setting: Spanish ICUs. Intervention: Opinion survey. Main variables of interest: Type of hospital, number of hospital beds, ICU and semicritical patient beds, usual bed availability in the ICU, use of restrictive admission criteria, use of LSTL criteria upon admission, and type of criterion used to decide LSTL. Results: A total of 43 (48%) hospitals participated in the study, with LSTL being a common practice in these centers (93%). LSTL was fundamentally decided on the basis of the presence of prior severe chronic disease (95%), observation of previously declared patient will (95%), prior functional limitation (85%), and qualitative futility of care (82%). Frequent ICU bed availability (77% of the hospitals) and the use of restrictive criteria (79% of the hospitals) were also associated to patient admission with LSTL. Conclusions: Admission to ICU with LSTL is a generalized practice in Spanish Hospitals. LSTL is decided based on physiological futility from an objective medical point of view, but also in observance of ethical and moral implications based on the qualitative futility of medical care. (C) 2012 Elsevier Espana, S.L. and SEMICYUC. All rights reserved.