Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study

Esteban, Andrés; Gordo, Federico; Solsona, J. F.; Alía, Inmaculada; Caballero, Jesús; Bouza, Carmen; Alcalá-Zamora, Juan; Cook, Deborah J.; Sánchez, Javier; Abizanda, R.; Miró, Gabriel; Cabo, M J Fernández Del; Miguel, Eugenio de; Santos, José Alberto Loureiro dos; Balerdi, B.

doi:10.1007/s00134-001-1111-7

Cited by 208 publications

(95 citation statements)

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“…participants had negative attitudes towards many key items of DNR orders. In contrast, several studies [11][12][13][14]34] reported that health care providers considered that treatments are unnecessary when there is no hope of recovery. Participants' preference to general use of LSTs may be related to their religious beliefs.…”

Section: Discussionmentioning

confidence: 99%

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Razban

Iranmanesh

Aliabadi

et al. 2016

World Journal of Emergency Medicine

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BACKGROUND: Life-sustaining treatments (LSTs) may prolong life but greatly decrease the quality of death. One factor influencing decision-making about withholding and withdrawing these treatments is the attitude of nurses. This study aimed to evaluate the attitude of critical care nurses towards life-sustaining treatments in South East Iran. METHODS:In this cross-sectional study, "Ethnicity and Attitudes towards Advance Care Directives Questionnaire" was used to investigate the attitude of 104 critical care nurses towards lifesustaining treatments in three hospitals affi liated to Kerman University of Medical Sciences. RESULTS:The fi ndings of this study indicated that although a majority of critical care nurses (77%) did not have personal desire for use of LSTs including CPR and mechanical ventilation, they had moderately negative to neutral attitude towards general use of LSTs (2.95 of 5).CONCLUSIONS: These fi ndings suggest that nurses' attitude towards LSTs can be changed by inclusion of specific courses about death, palliative care and life-sustaining treatments in undergraduate and postgraduate nursing curricula. Educating Muslim nurses about religious aspects of LSTs may also improve their attitudes.

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Section: Discussionmentioning

confidence: 99%

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Razban

Iranmanesh

Aliabadi

et al. 2016

World Journal of Emergency Medicine

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“…Low frequencies of LWs have also been documented in patients admitted to adult ICUs (0% to 13%) [18][19][20] and in units for the chronically critically ill (16%-38%). 21,22 These low LW rates are not unexpected, especially in the United States, given the paucity of advance care planning in America, 1 whether among the healthy, the elderly, the hospitalized, 23 those undergoing major surgical procedures, 24 or those with cancer.…”

Section: Discussionmentioning

confidence: 99%

Advance Directives in an Oncologic Intensive Care Unit: A Contemporary Analysis of their Frequency, Type, and Impact

Halpern¹,

Pastores²,

Chou

et al. 2011

Journal of Palliative Medicine

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Background: Our objective was to provide a contemporary analysis of the prevalence, types, and impact of advance health care directives in critically ill cancer patients. Methods: We retrospectively reviewed all intensive care unit (ICU) admissions ( January 1, 2006 to April 25, 2008 at an oncologic center and identified all patients who completed a living will (LW), or health care proxy (HCP), or neither prior to ICU admission. Demographics, clinical data, end-of-life (EOL) parameters and outcomes were compared among three groups: LWs, HCPs, and no LW or HCP. Results: Of 1,333 ICU admissions, 1,121 patients (84%) were included for analysis: 176 patients (15.7%) had LW, 534 (47.6%) had HCP and 411 (36.7%) had no LW or HCP. Patients with LW were significantly more likely to be older and white as compared to patients with HCP alone, or no LW or HCP. There were no significant demographic differences between patients with HCP or no LW or HCP. Patients with HCP alone, or no LW or HCP, were significantly more likely to have Medicaid than patients with LW. There were no differences noted in ICU care, EOL management, or outcomes among the three groups. Conclusions: The prevalence of LWs in patients admitted to our oncologic ICU is low. More than half of the remaining patients had designated HCPs. Older age and white race were associated with the presence of LWs. However, the presence of LWs or HCPs did not influence ICU care, EOL management or outcomes at our institution.

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“…Esse fato tem levado a necessidade de os médicos intensivistas restringirem a terapêutica dos seus enfermos vítimas de doença terminal. Atualmente, a maioria dos óbitos ocorridos em UTIs é precedida pela RST [15][16][17][18][19][20] . Inúmeros trabalhos [17][18][19][20] o melhor reconhecimento de que uma terapêutica possa ser fútil são os principais fatores envolvidos nessa diferença.…”

Section: Introductionunclassified

Avaliação dos óbitos ocorridos no Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC)

Moritz¹,

Beduschi²,

Machado³

2008

Rev. Assoc. Med. Bras.

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G2). A RST precedeu 38,2% dos óbitos no G1 e 2% no G2 (p<0,001). As principais terapêuticas recusadas/suspensas foram drogas vasoativas e antibióticos. No G1 cerca de 20% das mortes foi classificada como E/NE. No G2 considerou-se 5% das mortes evitáveis e 6,5% não esperadas (p<0,001). Os pacientes do G1 eram mais jovens e do sexo masculino (p<0,005). A ordem de não reanimar constava em 48,4% dos prontuários do G2 e em 6,3% do G1(p<0,001). Manobras de reanimação cardiorrespiratória (RCR) ocorreram em 23,4% no G1 e em 5,5% no G2(p<0,001). CONCLUSÃO. Na UTI, os pacientes que morreram eram mais jovens, receberam mais DVA e os óbitos foram mais freqüentemente precedidos da RST. Houve reanimação cardiorrespiratória em 5% das PCR nas enfermarias onde se constatou ordem de não reanimar em 48% dos prontuários. Poucos óbitos foram considerados E/NE. Não houve indícios de erro profissional ou institucional nesses óbitos.

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Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study

Abstract: The withholding and withdrawing of treatment was frequent in critically ill patients and was initiated primarily by physicians.

Cited by 208 publications

References 0 publications

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Critical care nurses' attitude towards life-sustaining treatments in South East Iran

Advance Directives in an Oncologic Intensive Care Unit: A Contemporary Analysis of their Frequency, Type, and Impact

Avaliação dos óbitos ocorridos no Hospital Universitário da Universidade Federal de Santa Catarina (HU/UFSC)

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