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 Valentin; Ximena 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

doi:10.1007/s00134-018-5196-7

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

Department of Medicine

Research output: Contribution to journal › Article › Research › peer-review

63 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 language	English
Pages (from-to)	1027-1038
Journal	Intensive Care Medicine
Volume	44
Issue number	7
DOIs	https://doi.org/10.1007/s00134-018-5196-7
Publication status	Published - 1 Jul 2018

Keywords

Elderly
Ethics
Intensive care
Life sustaining treatment
Withdrawal
Withholding

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10.1007/s00134-018-5196-7

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Guidet, B., Flaatten, H., Boumendil, A., Morandi, A., Andersen, F. H., Artigas, A., Bertolini, G., Cecconi, M., Christensen, S., Faraldi, L., Fjølner, J., Jung, C., Marsh, B., Moreno, R., Oeyen, S., Öhman, C. A., Pinto, B. B., Soliman, I. W., Szczeklik, W., ... Lawton, T. (2018). Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. Intensive Care Medicine, 44(7), 1027-1038. https://doi.org/10.1007/s00134-018-5196-7

Guidet, Bertrand ; Flaatten, Hans ; Boumendil, Ariane ; Morandi, Alessandro ; Andersen, Finn H. ; Artigas, Antonio ; Bertolini, Guido ; Cecconi, Maurizio ; Christensen, Steffen ; Faraldi, Loredana ; Fjølner, Jesper ; Jung, Christian ; Marsh, Brian ; Moreno, Rui ; Oeyen, Sandra ; Öhman, Christina Agwald ; Pinto, Bernardo Bollen ; Soliman, Ivo W. ; Szczeklik, Wojciech ; Valentin, Andreas ; Watson, Ximena ; Zafeiridis, Tilemachos ; De Lange, Dylan W. ; Schmutz, René ; Wimmer, Franz ; Eller, Philipp ; Zotter, Klemens ; De Buysscher, Pieter ; De Neve, Nikolaas ; Oeyen, Sandra ; Swinnen, Walter ; Pinto, Bernardo Bollen ; Abraham, Paul ; Hergafi, Leila ; Schefold, Joerg C. ; Biskup, Ewelina ; Taliadoros, Ioannis ; Piza, Petr ; Lauten, Alexander ; Sacher, Anna Lena ; Brenner, Thorsten ; Franz, Marcus ; Bloos, Frank ; Ebelt, Henning ; Schaller, Stefan J. ; Fuest, Kristina ; Rabe, Christian ; Dieck, Thorben ; Steiner, Stephan ; Graf, Tobias ; Nia, Amir M. ; Jung, Christian ; Janosi, Rolf Alexander ; Simon, Philipp ; Utzolino, Stefan ; Rahmel, Tim ; Barth, Eberhard ; Jung, Christian ; Schuster, Michael ; Fjølner, Jesper ; Dey, Nilanjan ; Sølling, Christoffer ; Rasmussen, Bodil Steen ; Christensen, Steffen ; Rodriguez, Enver ; Rebollo, Sergio ; Aguilar, Gerardo ; Masdeu, Gaspar ; Jaimes, Marián Irazábal ; Mira, Ángela Prado ; Bodi, Maria A. ; Barea Mendoza, Jesus A. ; López-Cuenca, Sonia ; Guzman, Marcela Homez ; Rico-Feijoo, Jesús ; Ibarz, Mercedes ; Alvarez, Josep Trenado ; Forceville, Xavier ; Besch, Guillaume ; Mentec, Herve ; Michel, Philippe ; Mateu, Philippe ; Michel, Philippe ; Vettoretti, Lucie ; Bourenne, Jeremy ; Marin, Nathalie ; Guillot, Max ; Aissaoui, Naida ; Goulenok, Cyril ; Thieulot-Rolin, Nathalie ; Messika, Jonathan ; Lamhaut, Lionel ; Guidet, Bertrand ; Charron, Cyril ; Dempsey, Ged ; Mathew, Shiju J. ; Raj, Ashok S. ; Grecu, Irina ; Cupitt, Jason ; Lawton, Tom. / Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. In: Intensive Care Medicine. 2018 ; Vol. 44, No. 7. pp. 1027-1038.

@article{ba38534405e94659aae786964e2e2528,

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

abstract = "{\textcopyright} 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).",

keywords = "Elderly, Ethics, Intensive care, Life sustaining treatment, Withdrawal, Withholding",

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

year = "2018",

month = jul,

day = "1",

doi = "10.1007/s00134-018-5196-7",

language = "English",

volume = "44",

pages = "1027--1038",

journal = "Intensive Care Medicine",

issn = "0342-4642",

number = "7",

}

Guidet, B, Flaatten, H, Boumendil, A, Morandi, A, Andersen, FH, Artigas, A, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjølner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Öhman, CA, Pinto, BB, Soliman, IW, Szczeklik, W, Valentin, A, Watson, X, Zafeiridis, T, De Lange, DW, Schmutz, R, Wimmer, F, Eller, P, Zotter, K, De Buysscher, P, De Neve, N, Oeyen, S, Swinnen, W, Pinto, BB, Abraham, P, Hergafi, L, Schefold, JC, Biskup, E, Taliadoros, I, Piza, P, Lauten, A, Sacher, AL, Brenner, T, Franz, M, Bloos, F, Ebelt, H, Schaller, SJ, Fuest, K, Rabe, C, Dieck, T, Steiner, S, Graf, T, Nia, AM, Jung, C, Janosi, RA, Simon, P, Utzolino, S, Rahmel, T, Barth, E, Jung, C, Schuster, M, Fjølner, J, Dey, N, Sølling, C, Rasmussen, BS, Christensen, S, Rodriguez, E, Rebollo, S, Aguilar, G, Masdeu, G, Jaimes, MI, Mira, ÁP, Bodi, MA, Barea Mendoza, JA, López-Cuenca, S, Guzman, MH, Rico-Feijoo, J, Ibarz, M, Alvarez, JT, Forceville, X, Besch, G, Mentec, H, Michel, P, Mateu, P, Michel, P, Vettoretti, L, Bourenne, J, Marin, N, Guillot, M, Aissaoui, N, Goulenok, C, Thieulot-Rolin, N, Messika, J, Lamhaut, L, Guidet, B, Charron, C, Dempsey, G, Mathew, SJ, Raj, AS, Grecu, I, Cupitt, J & Lawton, T 2018, 'Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit', Intensive Care Medicine, vol. 44, no. 7, pp. 1027-1038. https://doi.org/10.1007/s00134-018-5196-7

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. / Guidet, Bertrand; Flaatten, Hans; Boumendil, Ariane; Morandi, Alessandro; Andersen, Finn H.; Artigas, Antonio; Bertolini, Guido; Cecconi, Maurizio; Christensen, Steffen; Faraldi, Loredana; Fjølner, Jesper; Jung, Christian; Marsh, Brian; Moreno, Rui; Oeyen, Sandra; Öhman, Christina Agwald; Pinto, Bernardo Bollen; Soliman, Ivo W.; Szczeklik, Wojciech; Valentin, Andreas; Watson, Ximena; Zafeiridis, Tilemachos; De Lange, Dylan W.; Schmutz, René; Wimmer, Franz; Eller, Philipp; Zotter, Klemens; De Buysscher, Pieter; De Neve, Nikolaas; Oeyen, Sandra; Swinnen, Walter; Pinto, Bernardo Bollen; Abraham, Paul; Hergafi, Leila; Schefold, Joerg C.; Biskup, Ewelina; Taliadoros, Ioannis; Piza, Petr; Lauten, Alexander; Sacher, Anna Lena; Brenner, Thorsten; Franz, Marcus; Bloos, Frank; Ebelt, Henning; Schaller, Stefan J.; Fuest, Kristina; Rabe, Christian; Dieck, Thorben; Steiner, Stephan; Graf, Tobias; Nia, Amir M.; Jung, Christian; Janosi, Rolf Alexander; Simon, Philipp; Utzolino, Stefan; Rahmel, Tim; Barth, Eberhard; Jung, Christian; Schuster, Michael; Fjølner, Jesper; Dey, Nilanjan; Sølling, Christoffer; Rasmussen, Bodil Steen; Christensen, Steffen; Rodriguez, Enver; Rebollo, Sergio; Aguilar, Gerardo; Masdeu, Gaspar; Jaimes, Marián Irazábal; Mira, Ángela Prado; Bodi, Maria A.; Barea Mendoza, Jesus A.; López-Cuenca, Sonia; Guzman, Marcela Homez; Rico-Feijoo, Jesús; Ibarz, Mercedes; Alvarez, Josep Trenado; Forceville, Xavier; Besch, Guillaume; Mentec, Herve; Michel, Philippe; Mateu, Philippe; Michel, Philippe; Vettoretti, Lucie; Bourenne, Jeremy; Marin, Nathalie; Guillot, Max; Aissaoui, Naida; Goulenok, Cyril; Thieulot-Rolin, Nathalie; Messika, Jonathan; Lamhaut, Lionel; Guidet, Bertrand; Charron, Cyril; Dempsey, Ged; Mathew, Shiju J.; Raj, Ashok S.; Grecu, Irina; Cupitt, Jason; Lawton, Tom.

In: Intensive Care Medicine, Vol. 44, No. 7, 01.07.2018, p. 1027-1038.

Research output: Contribution to journal › Article › Research › peer-review

TY - JOUR

T1 - Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

AU - Guidet, Bertrand

AU - Flaatten, Hans

AU - Boumendil, Ariane

AU - Morandi, Alessandro

AU - Andersen, Finn H.

AU - Artigas, Antonio

AU - Bertolini, Guido

AU - Cecconi, Maurizio

AU - Christensen, Steffen

AU - Faraldi, Loredana

AU - Fjølner, Jesper

AU - Jung, Christian

AU - Marsh, Brian

AU - Moreno, Rui

AU - Oeyen, Sandra

AU - Öhman, Christina Agwald

AU - Pinto, Bernardo Bollen

AU - Soliman, Ivo W.

AU - Szczeklik, Wojciech

AU - Valentin, Andreas

AU - Watson, Ximena

AU - Zafeiridis, Tilemachos

AU - De Lange, Dylan W.

AU - Schmutz, René

AU - Wimmer, Franz

AU - Eller, Philipp

AU - Zotter, Klemens

AU - De Buysscher, Pieter

AU - De Neve, Nikolaas

AU - Oeyen, Sandra

AU - Swinnen, Walter

AU - Pinto, Bernardo Bollen

AU - Abraham, Paul

AU - Hergafi, Leila

AU - Schefold, Joerg C.

AU - Biskup, Ewelina

AU - Taliadoros, Ioannis

AU - Piza, Petr

AU - Lauten, Alexander

AU - Sacher, Anna Lena

AU - Brenner, Thorsten

AU - Franz, Marcus

AU - Bloos, Frank

AU - Ebelt, Henning

AU - Schaller, Stefan J.

AU - Fuest, Kristina

AU - Rabe, Christian

AU - Dieck, Thorben

AU - Steiner, Stephan

AU - Graf, Tobias

AU - Nia, Amir M.

AU - Jung, Christian

AU - Janosi, Rolf Alexander

AU - Simon, Philipp

AU - Utzolino, Stefan

AU - Rahmel, Tim

AU - Barth, Eberhard

AU - Jung, Christian

AU - Schuster, Michael

AU - Fjølner, Jesper

AU - Dey, Nilanjan

AU - Sølling, Christoffer

AU - Rasmussen, Bodil Steen

AU - Christensen, Steffen

AU - Rodriguez, Enver

AU - Rebollo, Sergio

AU - Aguilar, Gerardo

AU - Masdeu, Gaspar

AU - Jaimes, Marián Irazábal

AU - Mira, Ángela Prado

AU - Bodi, Maria A.

AU - Barea Mendoza, Jesus A.

AU - López-Cuenca, Sonia

AU - Guzman, Marcela Homez

AU - Rico-Feijoo, Jesús

AU - Ibarz, Mercedes

AU - Alvarez, Josep Trenado

AU - Forceville, Xavier

AU - Besch, Guillaume

AU - Mentec, Herve

AU - Michel, Philippe

AU - Mateu, Philippe

AU - Michel, Philippe

AU - Vettoretti, Lucie

AU - Bourenne, Jeremy

AU - Marin, Nathalie

AU - Guillot, Max

AU - Aissaoui, Naida

AU - Goulenok, Cyril

AU - Thieulot-Rolin, Nathalie

AU - Messika, Jonathan

AU - Lamhaut, Lionel

AU - Guidet, Bertrand

AU - Charron, Cyril

AU - Dempsey, Ged

AU - Mathew, Shiju J.

AU - Raj, Ashok S.

AU - Grecu, Irina

AU - Cupitt, Jason

AU - Lawton, Tom

PY - 2018/7/1

Y1 - 2018/7/1

N2 - © 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).

AB - © 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).

KW - Elderly

KW - Ethics

KW - Intensive care

KW - Life sustaining treatment

KW - Withdrawal

KW - Withholding

U2 - 10.1007/s00134-018-5196-7

DO - 10.1007/s00134-018-5196-7

M3 - Article

VL - 44

SP - 1027

EP - 1038

JO - Intensive Care Medicine

JF - Intensive Care Medicine

SN - 0342-4642

IS - 7

ER -

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

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Keywords

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