Olivier Lesieur1, Alexandre Herbland2, Séverin Cabasson3, Marie Anne Hoppe4, Frédéric Guillaume5, Maxime Leloup6. 1. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France; EA4569, University Paris Descartes, Paris, France. Electronic address: olivier.lesieur@gmail.com. 2. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France. Electronic address: alexandre.herbland@ch-larochelle.fr. 3. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France. Electronic address: severin.cabasson@gmail.com. 4. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France. Electronic address: mhoppe@hotmail.fr. 5. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France. Electronic address: frederic.guillaume@ch-larochelle.fr. 6. Intensive Care Unit, Saint Louis Hospital, La Rochelle, France. Electronic address: maxime.leloup@ch-larochelle.fr.
Abstract
BACKGROUND: Variability exists between ICUs in the limitations of therapy. Moreover practices may evolve over time. This single-center observational study aimed to compare withholding or withdrawing practices between 2012 and 2016. METHODS: For each period and patient concerned by limitations, withholding "do-not start", withholding "do-not-increase" and withdrawal measures were recorded. RESULTS: At a four-year interval, the rate of patients undergoing withholding or withdrawal rose from 10 to 23% and 4 to 7%, respectively. The proportion of patients dying in the ICU with previous limitations increased (53 to 89%), as did patients discharged alive despite withholding instructions (12 to 36%). The overall mortality (28%) was stable over time as the rate of failed resuscitation attempt declined (47 to 11%). In 2016 vs 2012, limitations started earlier following admission: 1 vs 7 days for withholding" do-not-start", 4 vs 8 for withholding "do-not-increase", 4 vs 7 for withdrawal. Notwithstanding the outcome and limitations applied, the median length of ICU stay of patients involved dropped from 13 days in 2012 to 8 days in 2016. CONCLUSION: A timely inclination to forego hopeless treatments resulted in a lower rate of failed resuscitations before death without change in global mortality.
BACKGROUND: Variability exists between ICUs in the limitations of therapy. Moreover practices may evolve over time. This single-center observational study aimed to compare withholding or withdrawing practices between 2012 and 2016. METHODS: For each period and patient concerned by limitations, withholding "do-not start", withholding "do-not-increase" and withdrawal measures were recorded. RESULTS: At a four-year interval, the rate of patients undergoing withholding or withdrawal rose from 10 to 23% and 4 to 7%, respectively. The proportion of patients dying in the ICU with previous limitations increased (53 to 89%), as did patients discharged alive despite withholding instructions (12 to 36%). The overall mortality (28%) was stable over time as the rate of failed resuscitation attempt declined (47 to 11%). In 2016 vs 2012, limitations started earlier following admission: 1 vs 7 days for withholding" do-not-start", 4 vs 8 for withholding "do-not-increase", 4 vs 7 for withdrawal. Notwithstanding the outcome and limitations applied, the median length of ICU stay of patients involved dropped from 13 days in 2012 to 8 days in 2016. CONCLUSION: A timely inclination to forego hopeless treatments resulted in a lower rate of failed resuscitations before death without change in global mortality.
Authors: Matthieu Le Dorze; Sara Martouzet; Etienne Cassiani-Ingoni; France Roussin; Alexandre Mebazaa; Lucas Morin; Nancy Kentish-Barnes Journal: Transpl Int Date: 2022-09-06 Impact factor: 3.842