Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital

U A López González; D Bautista Rentero; M Crespo Gómez; P Cárcamo Ibarra; A M Míguez Santiyán

doi:10.1016/j.redare.2024.02.007

Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital

Rev Esp Anestesiol Reanim (Engl Ed). 2024 Feb 9:S2341-1929(24)00027-1. doi: 10.1016/j.redare.2024.02.007. Online ahead of print.

Authors

U A López González¹, D Bautista Rentero², M Crespo Gómez³, P Cárcamo Ibarra⁴, A M Míguez Santiyán²

Affiliations

¹ Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain. Electronic address: ulogon@alumni.uv.es.
² Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain.
³ Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain.
⁴ Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, Spain.

PMID: 38342305
DOI: 10.1016/j.redare.2024.02.007

Abstract

Background: Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it.

Objective: To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU.

Design: Retrospective longitudinal study.

Ambit: Intensive care unit of a tertiary hospital.

Patients: People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019.

Interventions: None. This is an observational study.

Variables of interest: Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays.

Results: Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients.

Conclusions: Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.

Keywords: Cuidados intensivos; Infección hospitalaria; Intensive care; Inutilidad médica; Life-sustaining treatment limitation; Limitación del soporte vital; Medical futility; Nosocomial infections; Retiro de la atención; Withholding.