• S Iribarren-Diarasarri, K Latorre-García, T Muñoz-Martínez, Y Poveda-Hernández, J L Dudagoitia-Otaolea, S Martínez-Alutiz, C Castillo-Arenal, J M Ruiz-Zorrilla, and M Hernández-López.
• Servicio de Medicina Intensiva, Hospital Txagorritxu, Vitoria-Gasteiz, España. siribarren@iservicesmail.com
• Med Intensiva. 2007 Mar 1; 31 (2): 68-72.

ObjectiveTo analyze the limitation of therapeutic effort (LTE) in our Intensive Care Unit (ICU) and the variables associated with that decision.DesignProspective cohort study with a follow up of one year after discharge.SettingICU of a second level hospital.PatientsFour hundred and nine patients admitted during a two-year period.Main VariablesAPACHE II, NEMS, SOFA, quality of life (PAEEC) and mortality.ResultsLTE was performed in 49 (12%) patients. This decision was made by general agreement among the care team in 88% of cases and with the family in 73.5%. It was made on day 8 (4-20) with a SOFA score of 9 (4-13). Mortality in the LTE group was 69.4% in ICU, 92% in hospital, and 96% at 6 and 12 months. A logistic regression model showed that the variables associated with LTE were the following: NEMS score >or=30.7 (OR 12; 95% CI 3.7-39, p < 0.001), NEMS 26.6-30.6 (OR 8; 95% CI 2.5-25.6, p = 0.001), APACHE II > 30 (OR 7.6; 95% CI 2-29, p = 0.003), quality of life >or= 7 (OR 4.2; 95% CI 1.1-15, p = 0.03), age >or= 80 (OR 3.7, 95% CI 1.4-9.5, p = 0.007) and medical patient condition (OR 3.5; 95% CI 1.5-8, p = 0.003).ConclusionsLTE is a common practice and is usually performed among the care team and the patient's surrogates. The main variables associated with LSC are those related to the severity of illness, previous quality of life, medical disease and patient's age.

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