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Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study.

Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study.

Authors :
Rubio O
Arnau A
Cano S
Subirà C
Balerdi B
Perea ME
Fernández-Vivas M
Barber M
Llamas N
Altaba S
Prieto A
Gómez V
Martin M
Paz M
Quesada B
Español V
Montejo JC
Gomez JM
Miro G
Xirgú J
Ortega A
Rascado P
Sánchez JM
Marcos A
Tizon A
Monedero P
Zabala E
Murcia C
Torrejon I
Planas K
Añon JM
Hernandez G
Fernandez MD
Guía C
Arauzo V
Perez JM
Catalan R
Gonzalez J
Poyo R
Tomas R
Saralegui I
Mancebo J
Sprung C
Fernández R
Source :
Journal of intensive care [J Intensive Care] 2018 Apr 13; Vol. 6, pp. 24. Date of Electronic Publication: 2018 Apr 13 (Print Publication: 2018).
Publication Year :
2018

Abstract

Purpose: To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission.<br />Methods: This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals' characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients' characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models.<br />Results: We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0-8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p  < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59-2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7-44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission.<br />Conclusions: The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days.<br />Competing Interests: This study was approved by our Institutional Research Ethics Committee de la Fundació UNIO CATALANA HOSPITALS (reference number: CEIC 11/23). It has also approved by the local ethics committees, in accordance with Spanish regulations.All authors read and approved the final manuscript. This study was approved by our Institutional Department of Investigation in accordance with Spanish regulations.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Details

Language :
English
ISSN :
2052-0492
Volume :
6
Database :
MEDLINE
Journal :
Journal of intensive care
Publication Type :
Academic Journal
Accession number :
29686878
Full Text :
https://doi.org/10.1186/s40560-018-0283-y