OBJECTIVE: To analyze the limitation of therapeutic effort (LTE) in our Intensive Care Unit (ICU) and the variables associated with that decision. DESIGN: Prospective cohort study with a follow up of one year after discharge. SETTING: ICU of a second level hospital. PATIENTS: Four hundred and nine patients admitted during a two-year period. MAIN VARIABLES: APACHE II, NEMS, SOFA, quality of life (PAEEC) and mortality. RESULTS: 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). CONCLUSIONS: 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.
OBJECTIVE: To analyze the limitation of therapeutic effort (LTE) in our Intensive Care Unit (ICU) and the variables associated with that decision. DESIGN: Prospective cohort study with a follow up of one year after discharge. SETTING: ICU of a second level hospital. PATIENTS: Four hundred and nine patients admitted during a two-year period. MAIN VARIABLES: APACHE II, NEMS, SOFA, quality of life (PAEEC) and mortality. RESULTS: 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). CONCLUSIONS: 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.
Authors: 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 Journal: J Intensive Care Date: 2018-04-13
Authors: Ò Miró; A Alquézar-Arbé; P Llorens; F J Martín-Sánchez; S Jiménez; A Martín; G Burillo-Putze; J Jacob; E J García-Lamberechts; P Piñera; J González Del Castillo Journal: Med Intensiva (Engl Ed) Date: 2020-09-29