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

被引：116

作者：

Guidet, Bertrand ^{[1
,2
]}

Flaatten, Hans ^{[3
,4
]}

Boumendil, Ariane ^{[1
]}

Morandi, Alessandro ^{[5
,6
]}

Andersen, Finn H. ^{[7
,8
]}

Artigas, Antonio ^{[9
]}

Bertolini, Guido ^{[10
]}

Cecconi, Maurizio ^{[11
]}

Christensen, Steffen ^{[12
]}

Faraldi, Loredana ^{[13
]}

Fjolner, Jesper ^{[12
]}

Jung, Christian ^{[14
]}

Marsh, Brian ^{[15
]}

Moreno, Rui ^{[16
]}

Oeyen, Sandra ^{[17
]}

Ohman, Christina Agwald ^{[18
]}

Pinto, Bernardo Bollen ^{[19
]}

Soliman, Ivo W. ^{[20
]}

Szczeklik, Wojciech ^{[21
]}

Valentin, Andreas ^{[22
]}

Watson, Ximena ^{[11
]}

Zafeiridis, Tilemachos ^{[23
]}

De Lange, Dylan W. ^{[20
]}

机构：

[1] Hop St Antoine, Hop Paris, Serv Reanimat Med, 184 Rue Faubourg St Antoine, F-75012 Paris, France

[2] UPMC Univ Paris 06, Sorbonne Univ, INSERM, Inst Pierre Louis Epidemiol & Sante Publ,UMR S 11, F-75013 Paris, France

[3] Univ Bergen, Dept Clin Med, Bergen, Norway

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

[5] Hosp Ancelle Cremona, Dept Rehabil, Cremona, Italy

[6] Geriatr Res Grp, Brescia, Italy

[7] Alesund Hosp, Dept Anaesthesia & Intens Care, Alesund, Norway

[8] NTNU, Dept Circulat & Med Imaging, Trondheim, Norway

[9] Autonomous Univ Barcelona, Corporac Sanitaria Univ Parc Tauli, CIBER Enfermedades Resp, Dept Intens Care Med, Sabadell, Spain

[10] IRCCS Ist Ric Farmacol Mario Negri Villa Camozzi, Ctr Coordinamento GiViTI, Lab Epidemiol Clin, I-24020 Bergamo, Italy

[11] St Georges Univ Hosp, London, England

[12] Aarhus Univ Hosp, Dept Anaesthesia & Intens Care Med, Aarhus, Denmark

[13] Grande Osped Metropolitano Niguarda, Milan, Italy

[14] Univ Hosp, Dept Cardiol Pulmonol & Angiol, Dusseldorf, Germany

[15] Mater Misericordiae Univ Hosp, Dublin, Ireland

[16] Hosp Sao Jose, Ctr Hosp Lisboa Cent, Unidade Cuidados Intens Polivalente Neurocrit, Fac Ciencia Med Lisboa,Nova Med Sch, Lisbon, Portugal

[17] Ghent Univ Hosp, Dept Intens Care 1K12IC, Ghent, Belgium

[18] Karolinska Univ Hosp, Solna, Sweden

[19] Geneva Univ Hosp, Geneva, Switzerland

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

[21] Jagiellonian Univ, Med Coll, Intens Care & Perioperat Med Div, Krakow, Poland

[22] Kardinal Schwarzenberg Hosp, Schwarzach, Austria

[23] Gen Hosp Larissa, Intens Care Unit, Larisa, Greece

来源：

INTENSIVE CARE MEDICINE | 2018年 / 44卷 / 07期

关键词：

Elderly; Intensive care; Ethics; Life sustaining treatment; Withholding; Withdrawal; ILL ELDERLY-PATIENTS; MECHANICAL VENTILATION; HOSPITALIZED ADULTS; SERIOUSLY ILL; DECISIONS; VARIABILITY; ICU; MULTICENTER; PREFERENCES; PHYSICIANS;

D O I：

10.1007/s00134-018-5196-7

中图分类号：

R4 [临床医学];

学科分类号：

1002 ; 100602 ;

摘要：

To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. This prospective study included intensive care patients aged 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries. The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. ClinicalTrials.gov (ID: NTC03134807).

引用

页码：1027 / 1038

页数：12

共 37 条

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