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01-04-2009 | Original

End-of-life practices in 282 intensive care units: data from the SAPS 3 database

Authors: Élie Azoulay, Barbara Metnitz, Charles L. Sprung, Jean-François Timsit, François Lemaire, Peter Bauer, Benoît Schlemmer, Rui Moreno, Philipp Metnitz, on behalf of the SAPS 3 investigators

Published in: Intensive Care Medicine | Issue 4/2009

Abstract

Objective

To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database.

Methods

We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression.

Results

DFLSTs 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.

Conclusion

This 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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Title: End-of-life practices in 282 intensive care units: data from the SAPS 3 database
Authors: Élie Azoulay
Barbara Metnitz
Charles L. Sprung
Jean-François Timsit
François Lemaire
Peter Bauer
Benoît Schlemmer
Rui Moreno
Philipp Metnitz
on behalf of the SAPS 3 investigators
Publication date: 01-04-2009
Publisher: Springer-Verlag
Published in: Intensive Care Medicine / Issue 4/2009
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-008-1310-6

Keynote webinar | Spotlight on medication adherence

Springer Medicine

End-of-life practices in 282 intensive care units: data from the SAPS 3 database

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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