Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study
Abstract Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
BMC
2018-04-01
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| Series: | Journal of Intensive Care |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40560-018-0283-y |
| _version_ | 1811215744383320064 |
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| author | Olga Rubio Anna Arnau Sílvia Cano Carles Subirà Begoña Balerdi María Eugenía Perea Miguel Fernández-Vivas María Barber Noemí Llamas Susana Altaba Ana Prieto Vicente Gómez Mar Martin Marta Paz Belen Quesada Valentí Español Juan Carlos Montejo José Manuel Gomez Gloria Miro Judith Xirgú Ana Ortega Pedro Rascado Juan María Sánchez Alfredo Marcos Ana Tizon Pablo Monedero Elisabeth Zabala Cristina Murcia Ines Torrejon Kenneth Planas José Manuel Añon Gonzalo Hernandez María-del-Mar Fernandez Consuelo Guía Vanesa Arauzo José Miguel Perez Rosa Catalan Javier Gonzalez Rosa Poyo Roser Tomas Iñaki Saralegui Jordi Mancebo Charles Sprung Rafael Fernández |
| author_facet | Olga Rubio Anna Arnau Sílvia Cano Carles Subirà Begoña Balerdi María Eugenía Perea Miguel Fernández-Vivas María Barber Noemí Llamas Susana Altaba Ana Prieto Vicente Gómez Mar Martin Marta Paz Belen Quesada Valentí Español Juan Carlos Montejo José Manuel Gomez Gloria Miro Judith Xirgú Ana Ortega Pedro Rascado Juan María Sánchez Alfredo Marcos Ana Tizon Pablo Monedero Elisabeth Zabala Cristina Murcia Ines Torrejon Kenneth Planas José Manuel Añon Gonzalo Hernandez María-del-Mar Fernandez Consuelo Guía Vanesa Arauzo José Miguel Perez Rosa Catalan Javier Gonzalez Rosa Poyo Roser Tomas Iñaki Saralegui Jordi Mancebo Charles Sprung Rafael Fernández |
| author_sort | Olga Rubio |
| collection | DOAJ |
| description | Abstract Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days. |
| first_indexed | 2024-04-12T06:27:31Z |
| format | Article |
| id | doaj.art-e223cdc16f0f4a57bb76d556009217aa |
| institution | Directory Open Access Journal |
| issn | 2052-0492 |
| language | English |
| last_indexed | 2024-04-12T06:27:31Z |
| publishDate | 2018-04-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Intensive Care |
| spelling | doaj.art-e223cdc16f0f4a57bb76d556009217aa2022-12-22T03:44:06ZengBMCJournal of Intensive Care2052-04922018-04-01611910.1186/s40560-018-0283-yLimitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort studyOlga Rubio0Anna Arnau1Sílvia Cano2Carles Subirà3Begoña Balerdi4María Eugenía Perea5Miguel Fernández-Vivas6María Barber7Noemí Llamas8Susana Altaba9Ana Prieto10Vicente Gómez11Mar Martin12Marta Paz13Belen Quesada14Valentí Español15Juan Carlos Montejo16José Manuel Gomez17Gloria Miro18Judith Xirgú19Ana Ortega20Pedro Rascado21Juan María Sánchez22Alfredo Marcos23Ana Tizon24Pablo Monedero25Elisabeth Zabala26Cristina Murcia27Ines Torrejon28Kenneth Planas29José Manuel Añon30Gonzalo Hernandez31María-del-Mar Fernandez32Consuelo Guía33Vanesa Arauzo34José Miguel Perez35Rosa Catalan36Javier Gonzalez37Rosa Poyo38Roser Tomas39Iñaki Saralegui40Jordi Mancebo41Charles Sprung42Rafael Fernández43Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de ManresaHospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de ManresaHospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de ManresaHospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de ManresaHospital la Fe de ValenciaHospital General Yagué de BurgosHospital Virgen Arrixaca MurciaHospital de NavarraHospital Morales MesseguerHospital Universitario de CastellonHospital Rio HortegaHospital la MoncloaHospital Candelaria de TenerifeHospital Clínico Universitario de SalamancaFundación Jiménez DíazHospital Central de AsturiasHospital Universitario Doce de OctubreHospital Gregorio MarañonHospital MataroHospital de GranollersHospital Montecelo PontevedraCentro Hospitalario Universitario Santiago CompostelaHospital de la Sant Creu i Sant PauHospital Virgen de la ConchaHospital Xeral Cíes VigoClínica Universitaria de NavarraHospital Clínico Universitario de BarcelonaHospital Josep TruetaHospital de HenaresHospital Moisses BroggiHospital Virgen de la LuzHospital Infanta SofíaHospital Mútua de TerrassaHospital Parc TauliHospital de TerrassaHospital Virgen de las NievesHospital General de VicHospital Virgen Vega SalamancaHospital Son LlátzerHospital General de CatalunyaHospital de ÁrabaHospital de la Santa Creu i Sant PauHadassh Hebrew University Medical CenterHospital Sant Joan de Deu, Fundació Althaia Xarxa Universitaria de ManresaAbstract Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days.http://link.springer.com/article/10.1186/s40560-018-0283-yLimitations on life support techniquesPalliative careCritical careIntensive care units |
| spellingShingle | Olga Rubio Anna Arnau Sílvia Cano Carles Subirà Begoña Balerdi María Eugenía Perea Miguel Fernández-Vivas María Barber Noemí Llamas Susana Altaba Ana Prieto Vicente Gómez Mar Martin Marta Paz Belen Quesada Valentí Español Juan Carlos Montejo José Manuel Gomez Gloria Miro Judith Xirgú Ana Ortega Pedro Rascado Juan María Sánchez Alfredo Marcos Ana Tizon Pablo Monedero Elisabeth Zabala Cristina Murcia Ines Torrejon Kenneth Planas José Manuel Añon Gonzalo Hernandez María-del-Mar Fernandez Consuelo Guía Vanesa Arauzo José Miguel Perez Rosa Catalan Javier Gonzalez Rosa Poyo Roser Tomas Iñaki Saralegui Jordi Mancebo Charles Sprung Rafael Fernández Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study Journal of Intensive Care Limitations on life support techniques Palliative care Critical care Intensive care units |
| title | Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study |
| title_full | Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study |
| title_fullStr | Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study |
| title_full_unstemmed | Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study |
| title_short | Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study |
| title_sort | limitation of life support techniques at admission to the intensive care unit a multicenter prospective cohort study |
| topic | Limitations on life support techniques Palliative care Critical care Intensive care units |
| url | http://link.springer.com/article/10.1186/s40560-018-0283-y |
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