Characteristics of limiting life support therapies in patients who died in the ICU

Abstract

Introduction: withdraw and withhold life support therapies is an usual and ethically accepted practice.

Objectives: to determine the frequency, the directives and factors associated with withdrawing and withholding life support therapies in patients who died in ICU. Determine the frequency and characteristics of the record of this process in clinical history.

Design: multicentric observational study of cross section.

Setting: clinical histories of 8 public and private mixed ICUs in Uruguay were analyzed.

Patients: all patients over 18 years who died in a period of 6 consecutive months in 2011 were included.

Interventions: analysis of the characteristics of patients through review of clinical histories.

Results: we analyzed 210 patients who died. Withdrawing or withholding was identified in 63 (30%). 75% of the decisions consisted in withdraw therapeutic measures. Factors independently associated to withdrowing or withholding therapies were: an older age (OR 1.04 (95% CI 1.01-1.07), p = 0.001), a longer stay in ICU (OR 1.06 (95% CI 1, 02 - 1.11), p = 0.001), and the limitation for activities of daily living (OR 4.65 (95% CI 1.1 -19.6), p = 0.035). 70% of the decisions were recorded in the clinical history. The most frequently removed vital supports were: parenteral nutrition (100%), vasopressors (79%), enteral nutrition (64%) and antimicrobials (52%). Invasive mechanical ventilatory assistance was removed in 33% of the cases.

Conclusions: one third of patients die with LSTL. These types of decisions are associated with a poor quality of life, an older age and a longer stay in the ICU. One third of LTSV decisions are not registered.