• A Hernández-Tejedor, M C Martín Delgado, L Cabré Pericas, A Algora Weber, and Members of the study group EPIPUSE.
• Unidad de Cuidados Críticos, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, España. Electronic address: albertohmed@hotmail.com.
• Med Intensiva. 2015 Oct 1; 39 (7): 395-404.

ObjectiveLimitation of life-sustaining treatment (LLST) is a recommended practice in certain circumstances. Limitation practices are varied, and their application differs from one center to another. The present study evaluates the current situation of LLST practices in patients with prolonged admission to the ICU who suffer worsening of their condition.DesignA prospective, observational cohort study was carried out.SettingSeventy-five Spanish ICUs.PatientsA total of 589 patients suffering 777 complications or adverse events with organ function impairment after day 7 of admission, during a three-month recruitment period.Main Variables Of InterestThe timing of limitation, the subject proposing LLST, the degree of agreement within the team, the influence of LLST upon the doctor-patient-family relationship, and the way in which LLST is implemented.ResultsLLST was proposed in 34.3% of the patients presenting prolonged admission to the ICU with severe complications. The incidence was higher in patients with moderate to severe lung disease, cancer, immunosuppressive treatment or dependence for basic activities of daily living. LLST was finally implemented in 97% of the cases in which it was proposed. The decision within the medical team was unanimous in 87.9% of the cases. The doctor-patient-family relationship usually does not change or even improves in this situation.ConclusionLLST in ICUs is usually carried out under unanimous decision of the medical team, is performed more frequently in patients with severe comorbidity, and usually does not have a negative impact upon the relationship with the patients and their families.Copyright © 2013 Elsevier España, S.L.U. and SEMICYUC. All rights reserved.

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