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 Valentin & 3 others Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange

Research output: Contribution to journalArticle

14 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

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Intensive Care Units
Therapeutics
Decision Support Techniques
Mortality
Critical Care
Length of Stay
Prospective Studies
Population

Keywords

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

Cite this

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
Guidet, Bertrand ; Flaatten, Hans ; Boumendil, Ariane ; Morandi, Alessandro ; Andersen, Finn H ; Artigas, Antonio ; Bertolini, Guido ; Cecconi, Maurizio ; Christensen, Steffen ; Faraldi, Loredana ; Fjølner, Jesper ; Jung, Christian ; Marsh, Brian ; Moreno, Rui ; Oeyen, Sandra ; Öhman, Christina Agwald ; Pinto, Bernardo Bollen ; Soliman, Ivo W ; Szczeklik, Wojciech ; Valentin, Andreas ; Watson, Ximena ; Zafeiridis, Tilemachos ; De Lange, Dylan W. / Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. In: Intensive care medicine. 2018 ; Vol. 44, No. 7. pp. 1027-1038.
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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).",
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author = "Bertrand Guidet and Hans Flaatten and Ariane Boumendil and Alessandro Morandi and Andersen, {Finn H} and Antonio Artigas and Guido Bertolini and Maurizio Cecconi and Steffen Christensen and Loredana Faraldi and Jesper Fj{\o}lner and Christian Jung and Brian Marsh and Rui Moreno and Sandra Oeyen and {\"O}hman, {Christina Agwald} and Pinto, {Bernardo Bollen} and Soliman, {Ivo W} and Wojciech Szczeklik and Andreas Valentin and Ximena Watson and Tilemachos Zafeiridis and {De Lange}, {Dylan W}",
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Guidet, B, Flaatten, H, Boumendil, A, Morandi, A, Andersen, FH, Artigas, A, Bertolini, G, Cecconi, M, Christensen, S, Faraldi, L, Fjølner, J, Jung, C, Marsh, B, Moreno, R, Oeyen, S, Öhman, CA, Pinto, BB, Soliman, IW, Szczeklik, W, Valentin, A, Watson, X, Zafeiridis, T & De Lange, DW 2018, 'Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit', Intensive care medicine, vol. 44, no. 7, pp. 1027-1038. https://doi.org/10.1007/s00134-018-5196-7

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit. / Guidet, Bertrand; Flaatten, Hans; Boumendil, Ariane; Morandi, Alessandro; Andersen, Finn H; Artigas, Antonio; Bertolini, Guido; Cecconi, Maurizio; Christensen, Steffen; Faraldi, Loredana; Fjølner, Jesper; Jung, Christian; Marsh, Brian; Moreno, Rui; Oeyen, Sandra; Öhman, Christina Agwald; Pinto, Bernardo Bollen; Soliman, Ivo W; Szczeklik, Wojciech; Valentin, Andreas; Watson, Ximena; Zafeiridis, Tilemachos; De Lange, Dylan W.

In: Intensive care medicine, Vol. 44, No. 7, 07.2018, p. 1027-1038.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

AU - Guidet, Bertrand

AU - Flaatten, Hans

AU - Boumendil, Ariane

AU - Morandi, Alessandro

AU - Andersen, Finn H

AU - Artigas, Antonio

AU - Bertolini, Guido

AU - Cecconi, Maurizio

AU - Christensen, Steffen

AU - Faraldi, Loredana

AU - Fjølner, Jesper

AU - Jung, Christian

AU - Marsh, Brian

AU - Moreno, Rui

AU - Oeyen, Sandra

AU - Öhman, Christina Agwald

AU - Pinto, Bernardo Bollen

AU - Soliman, Ivo W

AU - Szczeklik, Wojciech

AU - Valentin, Andreas

AU - Watson, Ximena

AU - Zafeiridis, Tilemachos

AU - De Lange, Dylan W

PY - 2018/7

Y1 - 2018/7

N2 - 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).

AB - 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).

KW - Elderly

KW - Intensive care

KW - Ethics

KW - Life sustaining treatment

KW - Withholding

KW - Withdrawal

U2 - 10.1007/s00134-018-5196-7

DO - 10.1007/s00134-018-5196-7

M3 - Article

VL - 44

SP - 1027

EP - 1038

JO - Intensive care medicine

JF - Intensive care medicine

SN - 0342-4642

IS - 7

ER -