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

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abstract

  • 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).

authors

  • 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

publication date

  • July 2018