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End-of-life decisions in Greek intensive care units a multicenter cohort study.doc

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End-of-life decisions in Greek intensive care units a multicenter cohort study

Kranidiotisetal.CriticalCare2010,14:R228 /content/14/6/R228 RESEARCH OpenAccess End-of-lifedecisionsinGreekintensivecareunits: amulticentercohortstudy GeorgiosKranidiotis1,VasilikiGerovasili1,AthanasiosTasoulis2,ElliTripodaki1,IoannisVasileiadis3,EleniMagira4, VasilikiMarkaki1,ChristinaRoutsi1,AthanasiosPrekates4,TheodorosKyprianou5,Phyllis-MariaClouva-Molyvdas3, GeorgiosGeorgiadis6,IoannisFloros7,AndreasKarabinis8,SerafimNanas1* Abstract Introduction:Intensivecaremayprolongthedyingprocessinpatientswhohavebeenunresponsivetothe treatmentalreadyprovided.Limitationoflife-sustainingtherapy,byeitherwithholdingorwithdrawingsupport,is anethicallyacceptableandcommonworldwidepractice.Thepurposeofthepresentstudywastoexaminethe frequency,types,andrationaleoflimitinglifesupportinGreekintensivecareunits(ICUs),theclinicaland demographicparametersassociatedwithit,andtheparticipationofrelativesindecisionmaking. Methods:ThiswasaprospectiveobservationalstudyconductedineightGreekmultidisciplinaryICUs.Westudiedall consecutiveICUpatientswhodied,excludingthosewhostayedintheICUlessthan48hoursorwerebraindead. Results:Threehundredsixpatientscomposedthestudypopulation,withameanageof64yearsandamean APACHEIIscoreonadmissionof21.Ofstudypatients,41%receivedfullsupport,includingunsuccessful cardiopulmonaryresuscitation(CPR);48%diedafterwithholdingofCPR;8%,afterwithholdingofothertreatment modalitiesbesidesCPR;and3%,afterwithdrawaloftreatment.Patientsinwhomtherapywaslimitedhadalonger ICU(P0.01)andhospital(P=0.01)lengthofstay,alowerGlasgowComaScalescore(GCS)onadmission(P 0.01),ahigherAPACHEIIscore24hoursbeforedeath(P0.01),andweremorelikelytobeadmittedwitha neurologicdiagnosis(P0.01).Patientswhoreceivedfullsupportweremorelikelytobeadmittedwitheithera cardiovascular(P=0.02)ortraumadiagnosis(P=0.05)andtobesurgicalratherthanmedical(P=0.05).Themain factorsthatinfluencedthephysician’sdecisionwere,whenprovidingfullsupport,reversibilityofillnessand prognosticuncertainty,whereas,whenlimitingtherapy,unrespo