Limitation of life-sustaining treatment in patients with prolonged admission to the ICU. Current situation in Spain as seen from the EPIPUSE Study

• Published in: Medicina intensiva Vol. 39; no. 7; p. 395
• Main Authors: Hernández-Tejedor, A, Martín Delgado, M C, Cabré Pericas, L, Algora Weber, A
• Format: Journal Article
• Language: English; Spanish
• Published: Spain 01.10.2015
• Subjects: Adult; Aged; Aged, 80 and over; Comorbidity; Critical Care - ethics; Critical Care - statistics & numerical data; Critical Care - trends; Critical Care - utilization; Decision Making; Diagnosis-Related Groups; Disease Progression; Female; Hospital Mortality; Humans; Intensive Care Units - statistics & numerical data; Interprofessional Relations; Life Support Care - ethics; Life Support Care - statistics & numerical data; Life Support Care - trends; Life Support Care - utilization; Male; Medical Futility; Middle Aged; Patient Care Team; Professional-Family Relations; Prospective Studies; Spain; Withholding Treatment - ethics; Withholding Treatment - statistics & numerical data; Withholding Treatment - trends; Withholding Treatment - utilization; Tratamientos de soporte vital; Decision making; Multiple organ dysfunction syndrome; Bioethics; Decisiones al final de la vida; Síndrome de disfunción multiorgánica; Bioética; Life-sustaining treatment
• ISSN: 1578-6749
• DOI: 10.1016/j.medin.2014.06.005

Limitation of life-sustaining treatment (LLST) is a recommended practice in certain circumstances. Limitation practices are varied, and their application differs from one center to another. The present study evaluates the current situation of LLST practices in patients with prolonged admission to the ICU who suffer worsening of their condition. A prospective, observational cohort study was carried out. Seventy-five Spanish ICUs. A total of 589 patients suffering 777 complications or adverse events with organ function impairment after day 7 of admission, during a three-month recruitment period. The timing of limitation, the subject proposing LLST, the degree of agreement within the team, the influence of LLST upon the doctor-patient-family relationship, and the way in which LLST is implemented. LLST was proposed in 34.3% of the patients presenting prolonged admission to the ICU with severe complications. The incidence was higher in patients with moderate to severe lung disease, cancer, immunosuppressive treatment or dependence for basic activities of daily living. LLST was finally implemented in 97% of the cases in which it was proposed. The decision within the medical team was unanimous in 87.9% of the cases. The doctor-patient-family relationship usually does not change or even improves in this situation. LLST in ICUs is usually carried out under unanimous decision of the medical team, is performed more frequently in patients with severe comorbidity, and usually does not have a negative impact upon the relationship with the patients and their families.