• Elie Azoulay, Barbara Metnitz, Charles L Sprung, Jean-François Timsit, François Lemaire, Peter Bauer, Benoît Schlemmer, Rui Moreno, Philipp Metnitz, and SAPS 3 investigators.
• Service de Réanimation Médicale, Hôpital Saint-Louis et Université Paris 7, Assistance Publique, Hôpitaux de Paris, Paris, France. elie.azoulay@sls.ap-hop-paris.fr
• Intensive Care Med. 2009 Apr 1; 35 (4): 623-30.

ObjectiveTo report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database.MethodsWe reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression.ResultsDFLSTs 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.ConclusionThis large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.

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