Changes in limitations of life-sustaining treatments over time in a French intensive care unit: A prospective observational study

Lesieur, Olivier; Herbland, Alexandre; Cabasson, Séverin; Hoppe, Marie Anne; Guillaume, Frédéric; Leloup, Maxime

doi:10.1016/j.jcrc.2018.05.018

Cited by 18 publications

(9 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The trend we observed toward decreasing use of invasive intereventions at the end of life has been previously reported. One recent study within a French ICU found a substantial increase in over the course of a four-year interval in the proportion of patients dying in the ICU with limitations, an increase in patients discharged alive after treatment withholding decisions, and a reduction in failed resuscitation [15]. During that time mortality remained stable, which provides additional support for our finding that there may not be a stark tradeoff between invasive interventions and survival at the end of life.…”

Section: Discussionsupporting

confidence: 75%

Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients

et al. 2019

View full text Add to dashboard Cite

Background Critically ill patients may die despite invasive intervention. In this study, we examine trends in the application of two such treatments over a decade, namely, endotracheal ventilation and vasopressors and inotropes administration, as well as the impact of these trends on survival durations in patients who die within a month of ICU admission. Methods We considered observational data available from the MIMIC-III open-access ICU database and collected within a study period between year 2002 up to 2011. If a patient had multiple admissions to the ICU during the 30 days before death, only the first stay was analyzed, leading to a final set of 6,436 unique ICU admissions during the study period. We tested two hypotheses: (i) administration of invasive intervention during the ICU stay immediately preceding end-of-life would decrease over the study time period and (ii) time-to-death from ICU admission would also decrease, due to the decrease in invasive intervention administration. To investigate the latter hypothesis, we performed a subgroups analysis by considering patients with lowest and highest severity. To do so, we stratified the patients based on their SAPS I scores, and we considered patients within the first and the third tertiles of the score. We then assessed differences in trends within these groups between years 2002–05 vs. 2008–11. Results Comparing the period 2002–2005 vs. 2008–2011, we found a reduction in endotracheal ventilation among patients who died within 30 days of ICU admission (120.8 vs. 68.5 hours for the lowest severity patients, p<0.001; 47.7 vs. 46.0 hours for the highest severity patients, p = 0.004). This is explained in part by an increase in the use of non-invasive ventilation. Comparing the period 2002–2005 vs. 2008–2011, we found a reduction in the use of vasopressors and inotropes among patients with the lowest severity who died within 30 days of ICU admission (41.8 vs. 36.2 hours, p<0.001) but not among those with the highest severity. Despite a reduction in the use of invasive interventions, we did not find a reduction in the time to death between 2002–2005 vs. 2008–2011 (7.8 days vs. 8.2 days for the lowest severity patients, p = 0.32; 2.1 days vs. 2.0 days for the highest severity patients, p = 0.74). Conclusion We found that the reduction in the use of invasive treatments over time in patients with very poor prognosis did not shorten the time-to-death. These findings may be useful for goals of care discussions.

show abstract

Section: Discussionsupporting

confidence: 75%

Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The authors suggested that the lack of change was due to the already low CPR rate and high withholding rate. In a French single-center study by Lesieur et al, limitations increased by 16% from 2012 to 2016, while failed CPR decreased 36% . The present study found an increase from 1999 to 2016 of withholding (9%) and withdrawing (14%) life-sustaining therapies, whereas failed CPR decreased (-16%).…”

Section: Discussionmentioning

confidence: 79%

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016

Sprung

Ricou

Hartog

et al. 2019

JAMA

Self Cite

166

115

View full text Add to dashboard Cite

IMPORTANCE End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time.OBJECTIVE To determine the changes in end-of-life practices in European ICUs after 16 years. DESIGN, SETTING, AND PARTICIPANTS Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999)(2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision.

show abstract

“…Recently, a worldwide study reported hospital mortality of 69% in ICU patients after LST restriction and 16.7% in cases where such restrictions were not implemented 2 . Other studies have reported ICU mortality of 72%‐89% in patients with treatment limitation 1,4,8 …”

Section: Introductionmentioning

confidence: 99%

Intensive care patient survival after limiting life‐sustaining treatment—The FINNEOL* national cohort study

Adamski

Weigl

Lahtinen

et al. 2020

Acta Anaesthesiol Scand

View full text Add to dashboard Cite

The decision to limit life-sustaining treatment (LST) in the intensive care unit (ICU) is made when the patient's recovery is not anticipated, despite aggressive treatment. The practice of making such decisions in ICUs varies across geographical regions. 1 In some countries, endof-life practices are more common; a decision to withhold/withdraw LST has been reported in approximately 15% of ICU patients in the United States of America and Australia (range, 13%-18% and 12%-19%) and 11% in Europe (range 8%-15%). 2-4 In other countries, the practice is less frequent (eg 3% in South Asia) 2 and some regions do not have regulations regarding end-of-life care. 5 Decisions to limit LST are difficult because they are based on the subjective judgment of the treatment team, and these judgments can

show abstract

Changes in limitations of life-sustaining treatments over time in a French intensive care unit: A prospective observational study

Cited by 18 publications

References 40 publications

Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients

Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016

Intensive care patient survival after limiting life‐sustaining treatment—The FINNEOL* national cohort study

Contact Info

Product

Resources

About