Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit
| Title: | Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit |
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| Authors: | Guidet B.; Flaatten H.; Boumendil A.; Morandi A.; Andersen F. H.; Artigas A.; Bertolini G.; Cecconi M.; Christensen S.; Faraldi L.; Fjolner J.; Jung C.; Marsh B.; Moreno R.; Oeyen S.; Ohman C. A.; Pinto B. B.; Soliman I. W.; Szczeklik W.; Valentin A.; Watson X.; Zafeiridis T.; De Lange D. W.; Schmutz R.; Wimmer F.; Eller P.; Zotter K.; De Buysscher P.; De Neve N.; Swinnen W.; Abraham P.; Hergafi L.; Schefold J. C.; Biskup E.; Taliadoros I.; Piza P.; Lauten A.; Sacher A. L.; Brenner T.; Franz M.; Bloos F.; Ebelt H.; Schaller S. J.; Fuest K.; Rabe C.; Dieck T.; Steiner S.; Graf T.; Nia A. M.; Janosi R. A.; Simon P.; Utzolino S.; Rahmel T.; Barth E.; Schuster M.; Dey N.; Solling C.; Rasmussen B. S.; Rodriguez E.; Rebollo S.; Aguilar G.; Masdeu G.; Jaimes M. I.; Mira A. P.; Bodi M. A.; Barea Mendoza J. A.; Lopez-Cuenca S.; Guzman M. H.; Rico-Feijoo J.; Ibarz M.; Alvarez J. T.; Forceville X.; Besch G.; Mentec H.; Michel P.; Mateu P.; Vettoretti L.; Bourenne J.; Marin N.; Guillot M.; Aissaoui N.; Goulenok C.; Thieulot-Rolin N.; Messika J.; Lamhaut L.; Charron C.; Dempsey G.; Mathew S. J.; Raj A. S.; Grecu I.; Cupitt J.; Lawton T.; Clark R.; Popescu M.; Spittle N.; Faulkner M.; Cowton A.; Elloway E.; Williams P.; Reay M.; Chukkambotla S.; Kumar R.; Al-Subaie N.; Kent L.; Tamm T.; Kajtor I.; Burns K.; Pugh R.; Ostermann M.; Kam E.; Bowyer H.; Smith N.; Templeton M.; Henning J.; Goffin K.; Kapoor R.; Laha S.; Chilton P.; Khaliq W.; Crayford A.; Coetzee S.; Tait M.; Stoker W.; Gimenez M.; Pope A.; Camsooksai J.; Pogson D.; Quigley K.; Ritzema J.; Hormis A.; Boulanger C.; Balasubramaniam M.; Vamplew L.; Burt K.; Martin D.; Craig J.; Prowle J.; Doyle N.; Shelton J.; Scott C.; Donnison P.; Shelton S.; Frey C.; Ryan C.; Spray D.; Barnes V.; Barnes K.; Ridgway S.; Saha R.; Clark T.; Wood J.; Bolger C.; Bassford C.; Lewandowski J.; Zhao X.; Humphreys S.; Dowling S.; Richardson N.; Burtenshaw A.; Stevenson C.; Wilcock D.; Aidoni Z.; Aloizos S.; Tasioudis P.; Lampiri K.; Zisopoulou V.; Ravani I.; Pagaki E.; Antoniou A.; Katsoulas T. A.; Kounougeri A.; Marinakis G.; Tsimpoukas F.; Spyropoulou A.; Zygoulis P.; Kyparissi A.; Hayes I.; Kelly Y.; Westbrook A.; Fitzpatrick G.; Maheshwari D.; Motherway C.; Gupta M.; Gurjar M.; Maji I. M.; Negri G.; Spadaro S.; Nattino G.; Pedeferri M.; Boscolo Bozza A.; Rossi S.; Calicchio G.; Cubattoli L.; Di Lascio G.; Barbagallo M.; Berruto F.; Codazzi D.; Bottazzi A.; Fumagalli P.; Negro G.; Lupi G.; Savelli F.; Vulcano G. A.; Fumagalli R.; Marudi A.; Lefons U.; Lembo R.; Babini M.; Paggioro A.; Parrini V.; Zaccaria M.; Clementi S.; Gigliuto C.; Facondini F.; Pastorini S.; Munaron S.; Calamai I.; Bocchi A.; Adorni A.; Bocci M. G.; Cortegiani A.; Casalicchio T.; Mellea S.; Graziani E.; Barattini M.; Brizio E.; Rossi M.; van Dijk I.; van Lelyveld-Haas L. E. M.; Ramnarain D.; Jansen T.; Nooteboom F.; van der Voort P. H.; Dieperink W.; de Waard M. C.; de Smet A. G. E.; Bormans L.; Dormans T.; Hahn M.; Kemmerer N.; Strietzel H. F.; Dybwik K.; Legernaes T.; Klepstad P.; Olaussen E. B.; Olsen K. I.; Brresen O. M.; Bjorsvik G.; Maini S.; Fehrle L.; Czuczwar M.; Krawczyk P.; Zietkiewicz M.; Nowak L. R.; Kotfis K.; Cwyl K.; Gajdosz R.; Biernawska J.; Bohatyrewicz R.; Gawda R.; Grudzien P.; Nasilowski P.; Popek N.; Cyrankiewicz W.; Wawrzyniak K.; Wnuk M.; Maciejewski D.; Studzinska D.; Zukowski M.; Bernas S.; Piechota M.; Nowak I.; Fronczek J.; Serwa M.; Machala W.; Stefaniak J.; Wujtewicz M.; Maciejewski P.; Szymkowiak M.; Adamik B.; Catorze N.; Branco M. C.; Barros I.; Barros N.; Krystopchuk A.; Honrado T.; Sousa C.; Munoz F.; Rebelo M.; Gomes R.; Nunes J.; Dias C.; Fernandes A. M.; Petrisor C.; Constantin B.; Belskiy V.; Boskholov B.; Kawati R.; Sivik J.; Nauska J.; Smole D.; Parenmark F.; Lyren J.; Rockstroh K.; Ryden S.; Spangfors M.; Strinnholm M.; Walther S.; De Geer L.; Nordlund P.; Palsson S.; Zetterquist H.; Nilsson A.; Thiringer K.; Jungner M.; Bark B.; Nordling B.; Skold H.; Brorsson C.; Persson S.; Bergstrom A.; Berkius J.; Holmstrom J.; Nalapko Y. |
| Contributors: | Guidet, B.; Flaatten, H.; Boumendil, A.; Morandi, A.; Andersen, F. H.; Artigas, A.; Bertolini, G.; Cecconi, M.; Christensen, S.; Faraldi, L.; Fjolner, J.; Jung, C.; Marsh, B.; Moreno, R.; Oeyen, S.; Ohman, C. A.; Pinto, B. B.; Soliman, I. W.; Szczeklik, W.; Valentin, A.; Watson, X.; Zafeiridis, T.; De Lange, D. W.; Schmutz, R.; Wimmer, F.; Eller, P.; Zotter, K.; De Buysscher, P.; De Neve, N.; Swinnen, W.; Abraham, P.; Hergafi, L.; Schefold, J. C.; Biskup, E.; Taliadoros, I.; Piza, P.; Lauten, A.; Sacher, A. L.; Brenner, T.; Franz, M.; Bloos, F.; Ebelt, H.; Schaller, S. J.; Fuest, K.; Rabe, C.; Dieck, T.; Steiner, S.; Graf, T.; Nia, A. M.; Janosi, R. A.; Simon, P.; Utzolino, S.; Rahmel, T.; Barth, E.; Schuster, M.; Dey, N.; Solling, C.; Rasmussen, B. S.; Rodriguez, E.; Rebollo, S.; Aguilar, G.; Masdeu, G.; Jaimes, M. I.; Mira, A. P.; Bodi, M. A.; Barea Mendoza, J. A.; Lopez-Cuenca, S.; Guzman, M. H.; Rico-Feijoo, J.; Ibarz, M.; Alvarez, J. T.; Forceville, X.; Besch, G.; Mentec, H.; Michel, P.; Mateu, P.; Vettoretti, L.; Bourenne, J.; Marin, N.; Guillot, M.; Aissaoui, N.; Goulenok, C.; Thieulot-Rolin, N.; Messika, J.; Lamhaut, L.; Charron, C.; Dempsey, G.; Mathew, S. J.; Raj, A. S.; Grecu, I.; Cupitt, J.; Lawton, T.; Clark, R.; Popescu, M.; Spittle, N.; Faulkner, M.; Cowton, A.; Elloway, E.; Williams, P.; Reay, M. |
| Publisher Information: | Springer Science and Business Media Deutschland GmbH |
| Publication Year: | 2018 |
| Collection: | Padua Research Archive (IRIS - Università degli Studi di Padova) |
| Subject Terms: | Elderly; Ethic; Intensive care; Life sustaining treatment; Withdrawal; Withholding; Aged; 80 and over; Decision Making; Europe; Human; Intensive Care Unit; Male; Prospective Studie; Life Support Care; Withholding Treatment |
| Description: | Purpose: 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. Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. Results: 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. Conclusions: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country. Trial registration: ClinicalTrials.gov (ID: NTC03134807). |
| Document Type: | article in journal/newspaper |
| Language: | English |
| Relation: | info:eu-repo/semantics/altIdentifier/pmid/29774388; info:eu-repo/semantics/altIdentifier/wos/WOS:000439697600003; volume:44; issue:7; firstpage:1027; lastpage:1038; numberofpages:12; journal:INTENSIVE CARE MEDICINE; https://hdl.handle.net/11577/3459543 |
| DOI: | 10.1007/s00134-018-5196-7 |
| Availability: | https://hdl.handle.net/11577/3459543; https://doi.org/10.1007/s00134-018-5196-7 |
| Accession Number: | edsbas.D6C46D06 |
| Database: | BASE |