Process of life-sustaining treatment in general hospital: withholding and withdrawing

Background: Limitation of care (LC) is common practice in intensive care units (ICUs) and is associated with high mortality. There is no consensus on its application or the process in itself, sometimes leading futile prolongation of life and greater suffering. Objectives: We aimed to study types of... Deskribapen osoa

Egile nagusia: Socías Crespí, Lorenzo
Beste egile batzuk: Poyo-Guerrero Lahoz, Rosa
Formatua: Artikulua
Hizkuntza: Ingelesa
Argitaratua: Universitat de Barcelona: Observatori de Bioètica i Dret 2011
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Laburpena: Background: Limitation of care (LC) is common practice in intensive care units (ICUs) and is associated with high mortality. There is no consensus on its application or the process in itself, sometimes leading futile prolongation of life and greater suffering. Objectives: We aimed to study types of LC, associated mortality and factors that influence endof- life decisions. Material and method: This was a 2-year (2004-2006) prospective observational study of 97 patients in whom LC who was applied. Age, diagnosis on admission, severity scales, life support techniques, sedation and analgesia, modality of LC (withdrawal or withholding) and the justification for LC were recorded. Results: We applied LC to 6.6 % of the patients admitted to ICU with a mortality rate of 89.6 % (30.3 % of all deaths).The average stay of these patients was 10.5 ± 5.5 days compared to 5.6 ± 4.3 days for patients in whom LC was not implemented (p<0.001). The mean±SD length of stay from start of LC until death was 68±50 hours. The most frequent diagnosis on admission was sepsis (30.9%) and the futility was the reason given most often for LC (85%). Withdrawal of life support was used more frequently (65%) than withholding and was associated with higher mortality (95.3%). Conclusions: The severity criteria on admission to the ICU did not influence the decision to implement LC. Likewise, the modality of LC did not influence patient survival.