Estella Á, Lagares C, Furones MJ, Martínez López P, Lázaro Martín NI, Estebánez B, Gómez García JM, Rubio O, Vidal Tejedor B, Galarza L, Palomo Navarro M, López Camps V, Martín MC, Montejo JC, Avidan A, Sprung C. Limitation of life support treatments in Spanish Intensive Care Units: Analysis of the ETHICUS II study.
Med Intensiva 2024;
48:247-253. [PMID:
38538498 DOI:
10.1016/j.medine.2024.02.013]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/23/2024] [Indexed: 05/01/2024]
Abstract
OBJECTIVE
The aim of this study is to describe the results of Spanish ICUs in ETHICUS II study.
DESIGN
Planned substudy of patients from ETHICUS II study.
SETTING
12 Spanish ICU.
PATIENTS OR PARTICIPANTS
Patients admitted to Spanish ICU who died or in whom a limitation of life-sustaining treatment (LLST) was decided during a recruitment period of 6 months.
INTERVENTIONS
Follow-up of patients was performed until discharge from the ICU and 2 months after the decision of LLST or death.
MAIN VARIABLES OF INTEREST
Demographic characteristics, clinical profile, type of decision of LLST, time and form in which it was adopted. Patients were classified into 4 categories according to the ETHICUS II study protocol: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, failed cardiopulmonary resuscitation and patients with brain death.
RESULTS
A total of 795 patients were analyzed; 129 patients died after CPR, 129 developed brain death. LLST was decided in 537 patients, 485 died in the ICU, 90.3%. The mean age was 66.19 years ± 14.36, 63.8% of male patients. In 221 (41%) it was decided to withdraw life-sustaining treatments and in 316 (59%) withholding life-sustaining treatments. Nineteen patients (2.38%) had advance living directives.
CONCLUSIONS
The predominant clinical profile when LTSV was established was male patients over 65 years with mostly cardiovascular comorbidity. We observed that survival was higher in LLST decisions involving withholding of treatments compared to those in which withdrawal was decided. Spain has played a leading role in both patient and ICU recruitment participating in this worldwide multicenter study.
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