Variations in end-of-life practices in intensive care units worldwide (Ethicus-2): a prospective observational study

被引：99

作者：

Avidan, Alexander ^{[1
,2
]}

Sprung, Charles L. ^{[1
,2
]}

Schefold, Joerg C. ^{[3
]}

Ricou, Bara ^{[4
]}

Hartog, Christiane S. ^{[5
,6
]}

Nates, Joseph L. ^{[7
]}

Jaschinski, Ulrich ^{[8
]}

Lobo, Suzana M. ^{[9
]}

Joynt, Gavin M. ^{[10
]}

Lesieur, Olivier ^{[11
]}

Weiss, Manfred ^{[12
]}

Antonelli, Massimo ^{[13
]}

Bulow, Hans-Henrik ^{[14
]}

Bocci, Maria G. ^{[13
]}

Robertsen, Annette ^{[15
]}

Anstey, Matthew H. ^{[16
]}

Estebanez-Montiel, Belen ^{[17
]}

Lautrette, Alexandre ^{[18
]}

Gruber, Anastasiia ^{[19
]}

Estella, Angel ^{[20
]}

Mullick, Sudakshina ^{[21
]}

Sreedharan, Roshni ^{[22
]}

Michalsen, Andrej ^{[23
]}

Feldman, Charles ^{[24
,25
]}

Tisljar, Kai ^{[26
]}

Posch, Martin ^{[19
]}

Ovu, Steven ^{[7
]}

Tamowicz, Barbara ^{[27
]}

Demoule, Alexandre ^{[28
,29
]}

Ganz, Freda DeKeyser ^{[30
,31
]}

Pargger, Hans ^{[26
]}

Noto, Alberto ^{[32
]}

Metnitz, Philipp ^{[33
,38
]}

Zubek, Laszlo ^{[34
]}

de la Guardia, Veronica ^{[1
,2
]}

Danbury, Christopher M. ^{[36
]}

Szucs, Orsolya ^{[35
]}

Protti, Alessandro ^{[37
]}

Filipe, Mario

Simpson, Steven Q. ^{[39
]}

Green, Cameron ^{[40
]}

Giannini, Alberto M. ^{[41
]}

Soliman, Ivo W. ^{[42
]}

Piras, Claudio ^{[43
]}

Caser, Eliana B. ^{[44
]}

Hache-Marliere, Manuel ^{[45
,46
]}

Mentzelopoulos, Spyros ^{[47
]}

机构：

[1] Hebrew Univ Jerusalem, Hadassah Med Org, Dept Anesthesiol Crit Care & Pain Med, Jerusalem, Israel

[2] Hebrew Univ Jerusalem, Fac Med, Jerusalem, Israel

[3] Univ Bern, Dept Intens Care Med, Inselspital, Bern, Switzerland

[4] Univ Hosp Geneva, Dept Anesthesiol Pharmacol & Intens Care, Geneva, Switzerland

[5] Charite Univ Med Berlin, Dept Anesthesiol & Operat Intens Care Med, Berlin, Germany

[6] Klin Bavaria, Kreischa, Germany

[7] Univ Texas MD Anderson Canc Ctr, Crit Care Dept, Houston, TX 77030 USA

[8] Univ Hosp Augsburg, Dept Anesthesiol & Crit Care Med, Augsburg, Germany

[9] Sao Jose Rio Preto Sch Med, Intens Care Div, Sao Jose Do Rio Preto, SP, Brazil

[10] Chinese Univ Hong Kong, Dept Anaesthesia & Intens Care, Hong Kong, Peoples R China

[11] St Louis Gen Hosp, Intens Care Unit, La Rochelle, France

[12] Univ Hosp Med Sch, Clin Anaesthesiol & Intens Care Med, Ulm, Germany

[13] Fdn Policlin Univ A Gemelli IRCCS, Dept Anesthesiol & Intens Care Med, Rome, Italy

[14] Holbaek Univ Hosp, Dept Anesthesiol & Intens Care, Zealand Region, Denmark

[15] Oslo Univ Hosp, Div Emergencies & Crit Care, Dept Res & Dev, Oslo, Norway

[16] Sir Charles Gairdner Hosp, Perth, WA, Australia

[17] Univ Hosp La Paz, Dept Intens Care, Madrid, Spain

[18] Univ Hosp Clermont Ferrand, Med Intens Care Unit, Clermont Ferrand, France

[19] Med Univ Vienna, Ctr Med Stat Informat & Intelligent Syst, Vienna, Austria

[20] Univ Hosp SAS Jerez, Dept Intens Care, Jerez de la Frontera, Spain

[21] Tata Med Ctr, Crit Care Med, Kolkata, India

[22] Cleveland Clin, Inst Anesthesiol, Dept Intens Care & Resuscitat, Dept Gen Anesthesiol, Cleveland, OH 44106 USA

[23] Bodensee Tettnang Hosp, Dept Anesthesiol & Crit Care, Med Campus, Tettnang, Germany

[24] Univ Witwatersrand, Charlotte Maxeke Johannesburg Acad Hosp, Dept Internal Med, Johannesburg, South Africa

[25] Univ Witwatersrand, Fac Hlth Sci, Johannesburg, South Africa

[26] Univ Hosp & Univ Basel, Intens Care Unit, Basel, Switzerland

[27] Poznan Univ Med Sci, Fac Hlth Sci, Poznan, Poland

[28] Sorbonne Univ, Site Pitie Salpetriere, AP HP, Serv Med Intens Reanimat, Paris, France

[29] Sorbonne Univ, INSERM, UMRS1158 Neurophysiol Resp Expt, Paris, France

[30] Hadassah Hebrew Univ, Sch Nursing, Jerusalem, Israel

[31] Jerusalem Coll Technol, Fac Life & Hlth Sci, Jerusalem, Israel

[32] Univ Messina, Dept Human Pathol Adult & Evolut Age Gaetano Barr, Div Anesthesia & Intens Care, Messina, Italy

[33] LKH Univ Hosp Graz, Dept Gen Anaesthesiol Emergency & Intens Care Med, Graz, Austria

[34] Semmelweis Univ, Dept Anesthesiol & Intens Therapy, Budapest, Hungary

[35] Semmelweis Univ, Dept Surg & Intervent Gastroenterol 1, Budapest, Hungary

[36] Royal Berkshire Hosp, Dept Intens Care, Reading, Berks, England

[37] Fdn IRCCS Ca Granda, Osped Maggiore Policlin, Dept Anesthesia Intens Care & Emergency Med, Milan, Italy

[38] Semmelweis Univ, DPC Hosp Budapest, Dept Anesthesiol & Crit Care Med, Budapest, Hungary

[39] Univ Kansas, Dept Internal Med, Div Pulm Crit Care & Sleep Med, Kansas City, KS USA

[40] Peninsula Hlth, Dept Intens Care, Melbourne, Vic, Australia

[41] ASST Spedali Civili, Div Pediat Anesthesia & Intens Care, Brescia, Italy

[42] Univ Med Ctr Utrecht, Dept Intens Care, Utrecht, Netherlands

[43] Vitoria Apart Hosp, Serra, ES, Brazil

[44] Univ Fed Espirito Santo, Dept Internal Med, Vitoria, ES, Brazil

[45] CEDIMAT, Dept Crit Care Med, Santo Domingo, Dominican Rep

[46] Jacobi Med Ctr AECOM, Dept Internal Med, Bronx, NY USA

[47] Natl & Kapodistrian Univ Athens, Evaggelsimos Gen Hosp, Sch Med, Dept Intens Care Med 1, Athens, Greece

来源：

LANCET RESPIRATORY MEDICINE | 2021年 / 9卷 / 10期

关键词：

SUSTAINING TREATMENTS; ICU PATIENTS; WITHDRAWAL; DECISIONS; RESUSCITATION; GUIDELINES; ILLNESS; SUPPORT; ORDERS;

D O I：

10.1016/S2213-2600(21)00261-7

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

Background End-of-life practices vary among intensive care units (ICUs) worldwide. Differences can result in variable use of disproportionate or non-beneficial life-sustaining interventions across diverse world regions. This study investigated global disparities in end-of-life practices. Methods In this prospective, multinational, observational study, consecutive adult ICU patients who died or had a limitation of life-sustaining treatment (withholding or withdrawing life-sustaining therapy and active shortening of the dying process) during a 6-month period between Sept 1, 2015, and Sept 30, 2016, were recruited from 199 ICUs in 36 countries. The primary outcome was the end-of-life practice as defined by the end-of-life categories: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, or failed cardiopulmonary resuscitation (CPR). Patients with brain death were included in a separate predefined end-of-life category. Data collection included patient characteristics, diagnoses, end-of-life decisions and their timing related to admission and discharge, or death, with comparisons across different regions. Patients were studied until death or 2 months from the first limitation decision. Findings Of 87 951 patients admitted to ICU, 12 850 (14middot6%) were included in the study population. The number of patients categorised into each of the different end-of-life categories were significantly different for each region (p<0middot001). Limitation of life-sustaining treatment occurred in 10 401 patients (11middot8% of 87 951 ICU admissions and 80middot9% of 12 850 in the study population). The most common limitation was withholding life-sustaining treatment (5661 [44middot1%]), followed by withdrawing life-sustaining treatment (4680 [36middot4%]). More treatment withdrawing was observed in Northern Europe (1217 [52middot8%] of 2305) and Australia/New Zealand (247 [45middot7%] of 541) than in Latin America (33 [5middot8%] of 571) and Africa (21 [13middot0%] of 162). Shortening of the dying process was uncommon across all regions (60 [0middot5%]). One in five patients with treatment limitations survived hospitalisation. Death due to failed CPR occurred in 1799 (14%) of the study population, and brain death occurred in 650 (5middot1%). Failure of CPR occurred less frequently in Northern Europe (85 [3middot7%] of 2305), Australia/New Zealand (23 [4middot3%] of 541), and North America (78 [8middot5%] of 918) than in Africa (106 [65middot4%] of 162), Latin America (160 [28middot0%] of 571), and Southern Europe (590 [22middot5%] of 2622). Factors associated with treatment limitations were region, age, and diagnoses (acute and chronic), and country end-of-life legislation. Interpretation Limitation of life-sustaining therapies is common worldwide with regional variability. Withholding treatment is more common than withdrawing treatment. Variations in type, frequency, and timing of end-of-life decisions were observed. Recognising regional differences and the reasons behind these differences might help improve end-of-life care worldwide. Funding None. Copyright (c) 2021 Elsevier Ltd. All rights reserved.

引用

页码：1101 / 1110

页数：10

共 33 条

[1] Use of intensive care at the end of life in the United States: An epidemiologic study [J].

Angus, DC ;

Barnato, AE ;

Linde-Zwirble, WT ;

Weissfeld, LA ;

Watson, RS ;

Rickert, T ;

Rubenfeld, GD .

CRITICAL CARE MEDICINE, 2004, 32 (03) :638-643

[2] End-of-life practices in 282 intensive care units: data from the SAPS 3 database [J].

Azoulay, Elie ;

Metnitz, Barbara ;

Sprung, Charles L. ;

Timsit, Jean-Francois ;

Lemaire, Francois ;

Bauer, Peter ;

Schlemmer, Benoit ;

Moreno, Rui ;

Metnitz, Philipp .

INTENSIVE CARE MEDICINE, 2009, 35 (04) :623-630

[3] End-of-life decision-making and quality of ICU performance: an observational study in 84 Italian units [J].

Bertolini, Guido ;

Boffelli, Simona ;

Malacarne, Paolo ;

Peta, Mario ;

Marchesi, Mariano ;

Barbisan, Camillo ;

Tomelleri, Stefano ;

Spada, Simonetta ;

Satolli, Roberto ;

Gridelli, Bruno ;

Lizzola, Ivo ;

Mazzon, Davide .

INTENSIVE CARE MEDICINE, 2010, 36 (09) :1495-1504

[4] Limitation of life support: Frequency and practice in a Hong Kong intensive care unit [J].

Buckley, TA ;

Joynt, GM ;

Tan, PYH ;

Cheng, CAY ;

Yap, FHY .

CRITICAL CARE MEDICINE, 2004, 32 (02) :415-420

[5] Are religion and religiosity important to end-of-life decisions and patient autonomy in the ICU? The Ethicatt study [J].

Bulow, Hans-Henrik ;

Sprung, Charles L. ;

Baras, Mario ;

Carmel, Sara ;

Svantesson, Mia ;

Benbenishty, Julie ;

Maia, Paulo A. ;

Beishuizen, Albertus ;

Cohen, Simon ;

Nalos, Daniel .

INTENSIVE CARE MEDICINE, 2012, 38 (07) :1126-1133

[6] Guidelines for Family-Centered Care in the Neonatal, Pediatric, and Adult ICU [J].

Davidson, Judy E. ;

Aslakson, Rebecca A. ;

Long, Ann C. ;

Puntillo, Kathleen A. ;

Kross, Erin K. ;

Hart, Joanna ;

Cox, Christopher E. ;

Wunsch, Hannah ;

Wickline, Mary A. ;

Nunnally, Mark E. ;

Netzer, Giora ;

Kentish-Barnes, Nancy ;

Sprung, Charles L. ;

Hartog, Christiane ;

Coombs, Maureen ;

Gerritsen, Rik T. ;

Hopkins, Ramona O. ;

Franck, Linda S. ;

Skrobik, Yoanna ;

Kon, Alexander A. ;

Scruth, Elizabeth A. ;

Harvey, Maurene A. ;

Lewis-Newby, Mithya ;

White, Douglas B. ;

Swoboda, Sandra M. ;

Cooke, Colin R. ;

Levy, Mitchell M. ;

Azoulay, Elie ;

Curtis, J. Randall .

CRITICAL CARE MEDICINE, 2017, 45 (01) :103-128

[7] Development and Validation of the Good Outcome Following Attempted Resuscitation (GO-FAR) Score to Predict Neurologically Intact Survival After In-Hospital Cardiopulmonary Resuscitation [J].

Ebell, Mark H. ;

Jang, Woncheol ;

Shen, Ye ;

Geocadin, Romergryko G. .

JAMA INTERNAL MEDICINE, 2013, 173 (20) :1872-U24

[8] Association between education in EOL care and variability in EOL practice: a survey of ICU physicians [J].

Forte, Daniel Neves ;

Vincent, Jean Louis ;

Velasco, Irineu Tadeu ;

Park, Marcelo .

INTENSIVE CARE MEDICINE, 2012, 38 (03) :404-412

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

Guidet, Bertrand ;

Flaatten, Hans ;

Boumendil, Ariane ;

Morandi, Alessandro ;

Andersen, Finn H. ;

Artigas, Antonio ;

Bertolini, Guido ;

Cecconi, Maurizio ;

Christensen, Steffen ;

Faraldi, Loredana ;

Fjolner, Jesper ;

Jung, Christian ;

Marsh, Brian ;

Moreno, Rui ;

Oeyen, Sandra ;

Ohman, Christina Agwald ;

Pinto, Bernardo Bollen ;

Soliman, Ivo W. ;

Szczeklik, Wojciech ;

Valentin, Andreas ;

Watson, Ximena ;

Zafeiridis, Tilemachos ;

De Lange, Dylan W. .

INTENSIVE CARE MEDICINE, 2018, 44 (07) :1027-1038

[10] End-of-life decisions in Greek intensive care units: a multicenter cohort study [J].

Kranidiotis, Georgios ;

Gerovasili, Vasiliki ;

Tasoulis, Athanasios ;

Tripodaki, Elli ;

Vasileiadis, Ioannis ;

Magira, Eleni ;

Markaki, Vasiliki ;

Routsi, Christina ;

Prekates, Athanasios ;

Kyprianou, Theodoros ;

Clouva-Molyvdas, Phyllis-Maria ;

Georgiadis, Georgios ;

Floros, Ioannis ;

Karabinis, Andreas ;

Nanas, Serafim .

CRITICAL CARE, 2010, 14 (06)

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