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

Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H. Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W. Soliman, Wojciech Szczeklik, Andreas ValentinXimena Watson, Tilemachos Zafeiridis, Dylan W. De Lange, René Schmutz, Franz Wimmer, Philipp Eller, Klemens Zotter, Pieter De Buysscher, Nikolaas De Neve, Sandra Oeyen, Walter Swinnen, Bernardo Bollen Pinto, Paul Abraham, Leila Hergafi, Joerg C. Schefold, Ewelina Biskup, Ioannis Taliadoros, Petr Piza, Alexander Lauten, Anna Lena Sacher, Thorsten Brenner, Marcus Franz, Frank Bloos, Henning Ebelt, Stefan J. Schaller, Kristina Fuest, Christian Rabe, Thorben Dieck, Stephan Steiner, Tobias Graf, Amir M. Nia, Christian Jung, Rolf Alexander Janosi, Philipp Simon, Stefan Utzolino, Tim Rahmel, Eberhard Barth, Christian Jung, Michael Schuster, Jesper Fjølner, Nilanjan Dey, Christoffer Sølling, Bodil Steen Rasmussen, Steffen Christensen, Enver Rodriguez, Sergio Rebollo, Gerardo Aguilar, Gaspar Masdeu, Marián Irazábal Jaimes, Ángela Prado Mira, Maria A. Bodi, Jesus A. Barea Mendoza, Sonia López-Cuenca, Marcela Homez Guzman, Jesús Rico-Feijoo, Mercedes Ibarz, Josep Trenado Alvarez, Xavier Forceville, Guillaume Besch, Herve Mentec, Philippe Michel, Philippe Mateu, Philippe Michel, Lucie Vettoretti, Jeremy Bourenne, Nathalie Marin, Max Guillot, Naida Aissaoui, Cyril Goulenok, Nathalie Thieulot-Rolin, Jonathan Messika, Lionel Lamhaut, Bertrand Guidet, Cyril Charron, Ged Dempsey, Shiju J. Mathew, Ashok S. Raj, Irina Grecu, Jason Cupitt, Tom Lawton

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34 Citations (Scopus)

Abstract

© 2018, Springer-Verlag GmbH Germany, part of Springer Nature and ESICM. 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).
Original languageEnglish
Pages (from-to)1027-1038
JournalIntensive Care Medicine
Volume44
Issue number7
DOIs
Publication statusPublished - 1 Jul 2018

Keywords

  • Elderly
  • Ethics
  • Intensive care
  • Life sustaining treatment
  • Withdrawal
  • Withholding

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