Journal Article

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

Spyropoulou, Anastasia, Fronczek, Jakub, Calamai, Italo, Miguel Castelo Branco, Brresen, Ole Marius, Bowyer, Helen, Gomes, Rui, Grudzień, Paweł, Lewandowski, John, Krystopchuk, Andriy, de Lange, Dylan, Dowling, Susan, Westbrook, Andrew, Maheshwari, Darshana, Lyrén, Johanna, Wilcock, Danielle, Maini, Sameer, Jansen, Tim, Holmström, Johanna, Spray, Dominic, Mentec, Herve, Facondini, Francesca, Pagaki, Eumorfia, Williams, Patricia, Tasioudis, Polychronis, Jung, Christian, Zotter, Klemens, Utzolino, Stefan, Ostermann, Marlies, Zhao, Xiaobei, Kawati, Rafael, Clark, Thomas, Elloway, Esme, Codazzi, Daniela, Petrisor, Cristina, Messika, Jonathan, Gawda, Ryszard, Negro, Giancarlo, Bloos, Frank, Bergström, Anna, Janosi, Rolf Alexander, Camsooksai, Julie, Al-Subaie, Nawaf, Hormis, Anil, Simon, Philipp, Bocci, Maria Grazia, Eller, Philipp, Raj, Ashok S, Barbagallo, Maria, Gigliuto, Carmelo, Pålsson, Staffan, Clementi, Stefano, Strietzel, Hans Frank, Smith, Neil, Quigley, Kate, Parenmark, Fredric, Krawczyk, Pawel, Persson, Stefan, Bernas, Szymon, Gimenez, Marc, Adamik, Barbara, Goulenok, Cyril, Flaatten, Hans, Bolger, Cla

2018

Overview

PurposeTo document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.MethodsThis prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.ResultsLST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32–7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78–2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12–1.34) and SOFA score [OR of 1.07 (95% CI 1.05–1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.ConclusionsThe most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.Trial registrationClinicalTrials.gov (ID: NTC03134807).

• Publisher: Springer Nature B.V
• Subject: Adults / Age / Clinical decision making / Decision analysis / Decision making / Intensive care / Medical ethics / Mortality / Older people / Oldest old people / Palliative care / Patients / Quantitative analysis / Right to die