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

Intensive Care Medicine
Bertrand GuidetVIP1 study group

Abstract

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. This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. 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 fr...Continue Reading

References

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Citations

Apr 13, 2019·Journal of the American Geriatrics Society·Dylan W de LangeUNKNOWN VIP1 Study Group
Jun 14, 2019·Acta Anaesthesiologica Scandinavica·Linda BlockSilvana Naredi
Jul 7, 2019·Zeitschrift für Gerontologie und Geriatrie·Guido MichelsHans Jürgen Heppner
Jul 7, 2019·Medizinische Klinik, Intensivmedizin und Notfallmedizin·Guido MichelsHans Jürgen Heppner
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May 10, 2020·Anesthesia and Analgesia·Justin C De BiasioShahzad Shaefi
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Oct 4, 2019·Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine·Heidi KangasniemiSanna Hoppu
Mar 4, 2020·Intensive Care Medicine·Otavio T RanzaniMargaret S Herridge
Jan 18, 2020·European Journal of Trauma and Emergency Surgery : Official Publication of the European Trauma Society·Juan Antonio Llompart-PouMario Chico-Fernández
Jan 19, 2020·Acta Anaesthesiologica Scandinavica·Alma Nordenskjöld SyrousLinda Block
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Apr 26, 2021·Acta Anaesthesiologica Scandinavica·Finn H AndersenHans Flaatten
Jun 12, 2021·The Journal of Surgical Research·Rachel S MorrisChristopher J Tignanelli
Jul 27, 2021·Frontiers in Medicine·Raphael Romano BrunoChristian Jung
Aug 13, 2021·BMJ Supportive & Palliative Care·Jonathan MayesNazir Lone
Aug 9, 2021·The Lancet. Respiratory Medicine·Alexander AvidanUNKNOWN ETHICUS-2 Study Group
Aug 28, 2021·International Journal of Environmental Research and Public Health·Charles PayotRobert Larribau

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