ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

Abstract

Objective: To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure.

Design: Prospective, multicentrico.

Scope: 62 ICU from Spain between February 2018 and March 2019.

Patients: Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure.

Interventions: None.

Main interest variables: Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge.

Results: A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62-3.99).

Conclusions: Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Keywords: Calidad de vida; Denial of income; Futilidad; Futility; Limitación de los tratamientos de soporte vital; Limitation of life support treatments; Negación de ingreso; Quality of life.