• Medicina intensiva · Aug 2019

    Multicenter Study

    Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study.

    • V Blazquez, A Rodríguez, A Sandiumenge, E Oliver, B Cancio, M Ibañez, G Miró, E Navas, M Badía, M D Bosque, M T Jurado, M López, M Llauradó, N Masnou, T Pont, and M Bodí.
    • Intensive Care Unit, University Hospital Joan XXIII, Institut d'Investigació Sanitària Pere Virgili, Tarragona, Spain.
    • Med Intensiva. 2019 Aug 1; 43 (6): 352-361.

    ObjectiveTo determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission.Study DesignProspective multicenter study.SettingEleven ICUs.PatientsAll patients who died and/or had limitations on life support after ICU admission during a four-month period.VariablesPatient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early (<48h of admission) or late (≥48h). We performed univariate, multivariate analyses and CHAID (chi-square automatic interaction detection) analysis of variables associated with limitation of life support within 48h of ICU admission.Results3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%-84.2%). The median (p25-p75) time from admission to initial limitation was 2 (0-7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR=2.5; 95% CI: 1.5-4.4) and lung disease was the variable most strongly associated with early limitations (OR=12.29; 95% CI: 1.63-255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR=2.4; 95% CI: 1.1-5.5).ConclusionLimitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48h of admission.Copyright © 2018 Elsevier España, S.L.U. y SEMICYUC. All rights reserved.

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