End-of-life practices in 282 intensive care units: data from the SAPS 3 database

被引:164
作者
Azoulay, Elie [1 ,2 ]
Metnitz, Barbara [3 ]
Sprung, Charles L. [4 ]
Timsit, Jean-Francois [5 ,6 ]
Lemaire, Francois [7 ]
Bauer, Peter [3 ]
Schlemmer, Benoit [1 ,2 ]
Moreno, Rui [8 ]
Metnitz, Philipp [9 ]
机构
[1] Hop St Louis, Serv Reanimat Med, Paris, France
[2] Univ Paris 07, Hop Paris, AP HP, Paris, France
[3] Univ Vienna, Dept Med Stat, Vienna, Austria
[4] Hadassah Hebrew Univ, Med Ctr, Dept Anesthesiol & Crit Care Med, Jerusalem, Israel
[5] Hop A Michallon, Med ICU, F-38043 Grenoble 9, France
[6] UJF, INSERM, U823, Ctr Rech Inst Albert Bonniot,Team 11, F-38706 La Tronche, France
[7] Univ Paris 12, Hop Henri Mondor, AP HP, F-94010 Creteil, France
[8] Ctr Hosp Lisboa Cent EPE, Hosp St Antonio dos Capuchos, Unidade Cuidados Intensivos Polivalente, Lisbon, Portugal
[9] Univ Hosp Vienna, Dept Anesthesiol & Gen Intens Care, Vienna, Austria
关键词
Intensive care; End-of-life; SAPS; 3; Treatment withholding; Treatment withdrawal; CRITICALLY-ILL; DECISION-MAKING; SUPPORT; WITHDRAWAL; ICU; PATIENT; RECOMMENDATIONS; PHYSICIANS; DEATH;
D O I
10.1007/s00134-008-1310-6
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database. Methods: We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression. Results: DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after DFLSTs. Across the participating ICUs, hospital mortality in patients with DFLSTs ranged from 80.3 to 95.4% and time from admission to decisions ranged from 2 to 4 days. Independent predictors of decisions to forgo LSTs included 13 variables associated with increased incidence of DFLSTs and 7 variables associated with decrease incidence of DFLST. Among hospital and ICU-related variables, a higher number of nurses per bed was associated with increased incidence of DFLST, while availability of an emergency department in the same hospital, presence of a full time ICU-specialist and doctors presence during nights and week-ends were associated with a decreased incidence of DFLST. Conclusion: This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.
引用
收藏
页码:623 / 630
页数:8
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