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Attitudes towards end-of-life issues in intensive care unit among Italian anesthesiologists: a nation-wide survey

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Abstract

Background

The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs).

Methods

Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions.

Results

Eight hundred and five persons responded to the full list of questions. The highest proportion of respondents was of 36–45 years of age (34%) and catholic (66%). Almost 70% of responders declared that palliative/supportive care are applied in their ICU in case of futility of intensive treatments. Decision on withdrawing/withholding of life-sustaining treatments resulted from team consensus in most cases (58%). In more than 70% of responders’ ICUs, there is no collaboration with palliative/supportive care experts. Systematic recording of most frequent symptoms experienced by critically ill patients (e.g., pain, dyspnea, thirst) was not common. Vasopressors, extracorporeal therapies, blood component transfusions and invasive monitoring were the most commonly modified/interrupted measures in case of futility. Almost 85% of respondents have not received training in palliative/supportive care. The proportion of respondents whose institution has a palliative care team and who had training in palliative care was not homogenous across the country.

Conclusions

These data suggest that training in palliative care and its clinical application should be implemented in Italy. Efforts should be made to improve and homogenize the management of dying patients in ICU.

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Acknowledgments

We want to acknowledge Dr. Antonio Corcione, SIAARTI president, for approving this project.

We would like to acknowledge Emiliano Tizi (SIAARTI secretariat) for his technical support to prepare and promote this survey. We would like to thank all the Italian anesthesiologists who shared the practice of their ICU completing this survey.

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Authors and Affiliations

  1. Department of Biopathology and Medical Biotechnologies (DIBIMED), Section of Anesthesia, Analgesia, Intensive Care and Emergency, Policlinico Paolo Giaccone, University of Palermo, Via del vespro 129, 90127, Palermo, Italy

    Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti & Antonino Giarratano

  2. Anesthesia and Intensive Care and Pain Relief and Palliative/Supportive Care Unit, La Maddalena Cancer Center, Palermo, Italy

    Sebastiano Mercadante

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  1. Andrea Cortegiani
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  2. Vincenzo Russotto
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  3. Santi Maurizio Raineri
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  4. Cesare Gregoretti
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  5. Antonino Giarratano
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  6. Sebastiano Mercadante
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Corresponding author

Correspondence to Andrea Cortegiani.

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Conflict of interest

Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano, Sebastiano Mercadante declare they have no conflict of interest.

Sebastiano Mercadante is the Head of the Palliative Care Study Group of Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI).

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Cortegiani, A., Russotto, V., Raineri, S.M. et al. Attitudes towards end-of-life issues in intensive care unit among Italian anesthesiologists: a nation-wide survey. Support Care Cancer 26, 1773–1780 (2018). https://doi.org/10.1007/s00520-017-4014-z

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