| Title: |
End-of-life decisions in Greek intensive care units: a multicenter cohort study |
| Authors: |
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 |
| Source: |
Critical Care ; volume 14, issue 6 ; ISSN 1364-8535 |
| Publisher Information: |
Springer Science and Business Media LLC |
| Publication Year: |
2010 |
| Description: |
Introduction Intensive care may prolong the dying process in patients who have been unresponsive to the treatment already provided. Limitation of life-sustaining therapy, by either withholding or withdrawing support, is an ethically acceptable and common worldwide practice. The purpose of the present study was to examine the frequency, types, and rationale of limiting life support in Greek intensive care units (ICUs), the clinical and demographic parameters associated with it, and the participation of relatives in decision making. Methods This was a prospective observational study conducted in eight Greek multidisciplinary ICUs. We studied all consecutive ICU patients who died, excluding those who stayed in the ICU less than 48 hours or were brain dead. Results Three hundred six patients composed the study population, with a mean age of 64 years and a mean APACHE II score on admission of 21. Of study patients, 41% received full support, including unsuccessful cardiopulmonary resuscitation (CPR); 48% died after withholding of CPR; 8%, after withholding of other treatment modalities besides CPR; and 3%, after withdrawal of treatment. Patients in whom therapy was limited had a longer ICU ( P < 0.01) and hospital ( P = 0.01) length of stay, a lower Glasgow Coma Scale score (GCS) on admission ( P < 0.01), a higher APACHE II score 24 hours before death ( P < 0.01), and were more likely to be admitted with a neurologic diagnosis ( P < 0.01). Patients who received full support were more likely to be admitted with either a cardiovascular ( P = 0.02) or trauma diagnosis ( P = 0.05) and to be surgical rather than medical ( P = 0.05). The main factors that influenced the physician's decision were, when providing full support, reversibility of illness and prognostic uncertainty, whereas, when limiting therapy, unresponsiveness to treatment already offered, prognosis of underlying chronic disease, and prognosis of acute disorder. Relatives' participation in decision making occurred in 20% of cases and was ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1186/cc9380 |
| DOI: |
10.1186/cc9380.pdf |
| DOI: |
10.1186/cc9380/fulltext.html |
| Availability: |
https://doi.org/10.1186/cc9380; https://link.springer.com/content/pdf/10.1186/cc9380.pdf; https://link.springer.com/article/10.1186/cc9380/fulltext.html |
| Rights: |
http://creativecommons.org/licenses/by/2.0/ ; http://creativecommons.org/licenses/by/2.0/ |
| Accession Number: |
edsbas.4C9BF10D |
| Database: |
BASE |