Journal of Intensive Care (Apr 2018)
Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study
- 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
Affiliations
- Olga Rubio
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa
- Anna Arnau
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa
- Sílvia Cano
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa
- Carles Subirà
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa
- Begoña Balerdi
- Hospital la Fe de Valencia
- María Eugenía Perea
- Hospital General Yagué de Burgos
- Miguel Fernández-Vivas
- Hospital Virgen Arrixaca Murcia
- María Barber
- Hospital de Navarra
- Noemí Llamas
- Hospital Morales Messeguer
- Susana Altaba
- Hospital Universitario de Castellon
- Ana Prieto
- Hospital Rio Hortega
- Vicente Gómez
- Hospital la Moncloa
- Mar Martin
- Hospital Candelaria de Tenerife
- Marta Paz
- Hospital Clínico Universitario de Salamanca
- Belen Quesada
- Fundación Jiménez Díaz
- Valentí Español
- Hospital Central de Asturias
- Juan Carlos Montejo
- Hospital Universitario Doce de Octubre
- José Manuel Gomez
- Hospital Gregorio Marañon
- Gloria Miro
- Hospital Mataro
- Judith Xirgú
- Hospital de Granollers
- Ana Ortega
- Hospital Montecelo Pontevedra
- Pedro Rascado
- Centro Hospitalario Universitario Santiago Compostela
- Juan María Sánchez
- Hospital de la Sant Creu i Sant Pau
- Alfredo Marcos
- Hospital Virgen de la Concha
- Ana Tizon
- Hospital Xeral Cíes Vigo
- Pablo Monedero
- Clínica Universitaria de Navarra
- Elisabeth Zabala
- Hospital Clínico Universitario de Barcelona
- Cristina Murcia
- Hospital Josep Trueta
- Ines Torrejon
- Hospital de Henares
- Kenneth Planas
- Hospital Moisses Broggi
- José Manuel Añon
- Hospital Virgen de la Luz
- Gonzalo Hernandez
- Hospital Infanta Sofía
- María-del-Mar Fernandez
- Hospital Mútua de Terrassa
- Consuelo Guía
- Hospital Parc Tauli
- Vanesa Arauzo
- Hospital de Terrassa
- José Miguel Perez
- Hospital Virgen de las Nieves
- Rosa Catalan
- Hospital General de Vic
- Javier Gonzalez
- Hospital Virgen Vega Salamanca
- Rosa Poyo
- Hospital Son Llátzer
- Roser Tomas
- Hospital General de Catalunya
- Iñaki Saralegui
- Hospital de Áraba
- Jordi Mancebo
- Hospital de la Santa Creu i Sant Pau
- Charles Sprung
- Hadassh Hebrew University Medical Center
- Rafael Fernández
- Hospital Sant Joan de Deu, Fundació Althaia Xarxa Universitaria de Manresa
- DOI
- https://doi.org/10.1186/s40560-018-0283-y
- Journal volume & issue
-
Vol. 6,
no. 1
pp. 1 – 9
Abstract
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.
Keywords