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

Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas ValentinXimena Watson, Tilemachos Zafeiridis, Dylan W De Lange

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.

METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.

RESULTS: LST 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.

CONCLUSIONS: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.

TRIAL REGISTRATION: ClinicalTrials.gov (ID: NTC03134807).

Original languageEnglish
Pages (from-to)1027-1038
Number of pages12
JournalIntensive care medicine
Volume44
Issue number7
Early online date17 May 2018
DOIs
Publication statusPublished - Jul 2018

Keywords

  • Elderly
  • Intensive care
  • Ethics
  • Life sustaining treatment
  • Withholding
  • Withdrawal

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    Guidet, B., Flaatten, H., Boumendil, A., Morandi, A., Andersen, F. H., Artigas, A., ... De Lange, D. W. (2018). Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. Intensive care medicine, 44(7), 1027-1038. https://doi.org/10.1007/s00134-018-5196-7