Analysis of management protocols regarding ineffective maintenance of organ functions in patients treated at the Intensive Care Unit of the University Hospital in Wroclaw

Abstract

Background Prolonged support of organ functions without therapeutic benefit represents a serious problem of therapy in intensive care units (ICUs). This kind of treatment, called “futile therapy”, prolongs the process of dying and should be avoided. In Poland, the guidelines and protocol defining the best clinical practice for the avoidance of futile therapy in ICUs was published in 2014. The aim of study was to analyse the protocols concerning futile therapy in the general ICU in the University Hospital in Wrocław, Poland during the years 2015–2018. Methods The content of protocols was analysed. The protocols contained information on clinical problems, ethical and social aspects, data on communication with relatives, and therapeutic procedures regarded as futile and consequently withheld or withdrawn. Results During the study 1660 patients were treated in the ICU, of whom 557 patients died. Protocols regarding futile therapy were analysed in 146 patients. The diagnosis before starting the protocol was multiorgan failure (56%), permanent CNS injury (39%), respiratory failure (3%), and circulatory failure (2%). The withholding of therapeutic procedures was preferred, and the cases of withdrawal were rare. All patients with protocols died during hospital stay, 81.5% of them in the ICU. Conclusions The protocols concerning futile therapy were instituted in 1 in 10 patients treated in the ICU in Wrocław, which comprised was nearly one-fifth of all ICU deaths. The withholding of futile therapeutic procedures was preferred in comparison to withdrawing. Communication with relatives was essential to the process of avoiding futile therapy.

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

“…The higher mortality in Polish ICUs compared with other European countries [25], which has been under debate in recent years, is rather due to differences in patient populations, indications for ICU admission, the availability of ICU beds and the organization of end-of-life care in Poland. This is also due to the skeptical attitude of some practitioners regarding guidelines on futile therapy [26,27] and official ICU admission criteria [28]. Although patients admitted to Polish ICUs are more often at higher risk of death compared with other countries, ICU mortality observed in the Silesian Registry of Intensive Care Units was lower than that predicted by the APACHE II score [29].…”

Validation of APACHE II, APACHE III and SAPS II scores in short- and long-term mortality prediction in a mixed intensive care unit in Poland: a cohort study

“…The higher mortality in Polish ICUs compared with other European countries (25), which has been under debate in recent years, is rather due to differences in patient populations, indications for ICU admission, the availability of ICU beds and the organization of end-of-life care in Poland. This is also due to the skeptical attitude of some practitioners regarding guidelines on futile therapy (26,27) (30). The cause of this phenomenon appears to be complex, and may result from substantial differences between the patient population in our unit (mixed admissions, including post-operative cases as the rst priority) and the target populations these prognostic models were developed for.…”

Validation of APACHE II, APACHE III and SAPS II scores in in-hospital and one year mortality prediction in a mixed intensive care unit in Poland: a cohort study

“…The higher mortality in Polish ICUs compared with other European countries (25), which has been under debate in recent years, is rather due to differences in patient populations, indications for ICU admission, the availability of ICU beds and the organization of end-of-life care in Poland. This is also due to the skeptical attitude of some practitioners regarding guidelines on futile therapy (26,27) and o cial ICU admission criteria (28). Although patients admitted to Polish ICUs are more often at higher risk of death compared with other countries, ICU mortality observed in the Silesian Registry of Intensive Care Units was lower than that predicted by the APACHE II score (29).…”