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Intensive Care Medicine
Published in: Intensive Care Medicine 10/2015

01-10-2015 | Original

Respective impact of no escalation of treatment, withholding and withdrawal of life-sustaining treatment on ICU patients’ prognosis: a multicenter study of the Outcomerea Research Group

Authors: Alexandre Lautrette, Maïté Garrouste-Orgeas, Pierre-Marie Bertrand, Dany Goldgran-Toledano, Samir Jamali, Virginie Laurent, Laurent Argaud, Carole Schwebel, Bruno Mourvillier, Michaël Darmon, Stéphane Ruckly, Anne-Sylvie Dumenil, Virginie Lemiale, Bertrand Souweine, Jean-François Timsit, Outcomerea Study Group

Published in: Intensive Care Medicine | Issue 10/2015

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Abstract

Purpose

To assess the prevalence of decisions to forgo life-sustaining treatment (DFLST), the patients characteristics, and to estimate the impact of DFLST stages on mortality.

Methods

Observational study of a prospective database between 2005 and 2012 from 13 ICUs. DFLST were defined as follows: no escalation of treatment (stage 1), not to start or escalate treatment even if such treatment is considered in the future; withholding (stage 2), not to start or escalate necessary treatment; withdrawal (stage 3), to stop necessary treatment. The impact of daily DFLST stage on day-30 hospital mortality was tested with a discrete-time Cox’s model and adjusted for admission severity and daily SOFA score.

Results

Of 10,080 patients, 1290 (13 %) made DFLST. The highest DFLST stage during the ICU stay was no escalation of treatment in 339 (26 %) patients, withholding in 502 (39 %) patients, and withdrawal in 449 (35 %) patients. Older patients, patients with at least one chronic disease, and patients with greater ICU severity were significantly more numerous in the DFLST group. Day-30 mortality was 13 % for non-DFLST patients, 35 % for no escalation of treatment, 75 % for withholding, 93 % for withdrawal. After adjustment, an increase in day-30 mortality was associated with withholding and withdrawal (hazard ratio 95 % CI 5.93 [4.95–7.12] and 20.05 [15.58–25.79], P < 0.0001), but not with no escalation of treatment (HR 1.14 [0.91–1.44], P = 0.25).

Conclusions

DFLST were made in 13 % of ICU patients. Withholding, withdrawal, older age, more comorbidities, and higher severity of illness were associated with higher mortality. No escalation of treatment was not associated with increased mortality.
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Metadata
Title
Respective impact of no escalation of treatment, withholding and withdrawal of life-sustaining treatment on ICU patients’ prognosis: a multicenter study of the Outcomerea Research Group
Authors
Alexandre Lautrette
Maïté Garrouste-Orgeas
Pierre-Marie Bertrand
Dany Goldgran-Toledano
Samir Jamali
Virginie Laurent
Laurent Argaud
Carole Schwebel
Bruno Mourvillier
Michaël Darmon
Stéphane Ruckly
Anne-Sylvie Dumenil
Virginie Lemiale
Bertrand Souweine
Jean-François Timsit
Outcomerea Study Group
Publication date
01-10-2015
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 10/2015
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-015-3944-5

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