Limitation of therapeutic effort after ICU admission. Analysis of related factors

• Published in: Medicina intensiva Vol. 31; no. 2; pp. 68 - 72
• Main Authors: Iribarren-Diarasarri, S, Latorre-García, K, Muñoz-Martínez, T, Poveda-Hernández, Y, Dudagoitia-Otaolea, J L, Martínez-Alutiz, S, Castillo-Arenal, C, Ruiz-Zorrilla, J M, Hernández-López, M
• Format: Journal Article
• Language: Spanish
• Published: Spain 01.03.2007
• Subjects: Age Factors; Aged; Aged, 80 and over; Case Management - ethics; Cohort Studies; Comorbidity; Critical Care - ethics; Critical Care - methods; Female; Follow-Up Studies; Humans; Intensive Care Units; Life Support Care; Male; Middle Aged; Palliative Care - ethics; Palliative Care - methods; Patient Care Team; Patient Discharge; Prognosis; Prospective Studies; Quality of Life; Refusal to Treat - ethics; Severity of Illness Index; Survival Analysis; Terminal Care - ethics; Terminal Care - methods
• ISSN: 0210-5691

To analyze the limitation of therapeutic effort (LTE) in our Intensive Care Unit (ICU) and the variables associated with that decision. Prospective cohort study with a follow up of one year after discharge. ICU of a second level hospital. Four hundred and nine patients admitted during a two-year period. APACHE II, NEMS, SOFA, quality of life (PAEEC) and mortality. LTE was performed in 49 (12%) patients. This decision was made by general agreement among the care team in 88% of cases and with the family in 73.5%. It was made on day 8 (4-20) with a SOFA score of 9 (4-13). Mortality in the LTE group was 69.4% in ICU, 92% in hospital, and 96% at 6 and 12 months. A logistic regression model showed that the variables associated with LTE were the following: NEMS score >or=30.7 (OR 12; 95% CI 3.7-39, p < 0.001), NEMS 26.6-30.6 (OR 8; 95% CI 2.5-25.6, p = 0.001), APACHE II > 30 (OR 7.6; 95% CI 2-29, p = 0.003), quality of life >or= 7 (OR 4.2; 95% CI 1.1-15, p = 0.03), age >or= 80 (OR 3.7, 95% CI 1.4-9.5, p = 0.007) and medical patient condition (OR 3.5; 95% CI 1.5-8, p = 0.003). LTE is a common practice and is usually performed among the care team and the patient's surrogates. The main variables associated with LSC are those related to the severity of illness, previous quality of life, medical disease and patient's age.