Original

Intensive Care Medicine

, Volume 35, Issue 4, pp 623-630

End-of-life practices in 282 intensive care units: data from the SAPS 3 database

  • Élie AzoulayAffiliated withService de Réanimation Médicale, Hôpital Saint-Louis et Université Paris 7, Assistance Publique, Hôpitaux de Paris Email author 
  • , Barbara MetnitzAffiliated withDepartment of Medical Statistics, University of Vienna
  • , Charles L. SprungAffiliated withDepartment of Anesthesiology and Critical Care Medicine, Hadassah Hebrew University Medical Center
  • , Jean-François TimsitAffiliated withMedical ICU, Hôpital A. MichallonTeam 11, Outcome of Cancer and Critical Illnesses. UJF-INSERM U823, Centre de Recherche Institut Albert Bonniot
  • , François LemaireAffiliated withAssistance Publique Hop de Paris, Hopital H. Mondor, Paris 12 University
  • , Peter BauerAffiliated withDepartment of Medical Statistics, University of Vienna
  • , Benoît SchlemmerAffiliated withService de Réanimation Médicale, Hôpital Saint-Louis et Université Paris 7, Assistance Publique, Hôpitaux de Paris
  • , Rui MorenoAffiliated withUnidade de Cuidados Intensivos Polivalente, Hospital de St. António dos Capuchos, Centro Hospitalar de Lisboa Central E.P.E
  • , Philipp MetnitzAffiliated withDepartment of Anesthesiology and General Intensive Care, University Hospital of Vienna
    • , on behalf of the SAPS 3 investigators

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Abstract

Objective

To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database.

Methods

We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression.

Results

DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after DFLSTs. Across the participating ICUs, hospital mortality in patients with DFLSTs ranged from 80.3 to 95.4% and time from admission to decisions ranged from 2 to 4 days. Independent predictors of decisions to forgo LSTs included 13 variables associated with increased incidence of DFLSTs and 7 variables associated with decrease incidence of DFLST. Among hospital and ICU-related variables, a higher number of nurses per bed was associated with increased incidence of DFLST, while availability of an emergency department in the same hospital, presence of a full time ICU-specialist and doctors presence during nights and week-ends were associated with a decreased incidence of DFLST.

Conclusion

This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.

Keywords

Intensive care End-of-life SAPS 3 Treatment withholding Treatment withdrawal