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Pasieka P, Surówka A, Fronczek J, Skwara E, Czuczwar M, Borys M, Krawczyk P, Ziętkiewicz M, Nowak ŁR, Żukowski M, Kotfis K, Cwyl K, Skowronek J, Solek-Pastuszka J, Biernawska J, Grudzień P, Nasiłowski P, Popek N, Cyrankiewicz W, Sierakowska K, Mudyna W, Białka S, Studzińska D, Bernas S, Piechota M, Machała W, Sadowski Ł, Stefaniak J, Owczuk R, Szymkowiak M, Gawda R, Kozera N, Adamik B, Goździk W, Wieczorek A, Janc J, Kluzik A, Trzebicki J, Zatorski P, Gola W, Hymczak H, Krzych LJ, Czajka S, Kościuczuk U, Kudliński B, Flaatten H, Szczeklik W. Prevalence of life-sustaining treatment limitations in Polish very old intensive care patients (VIPs). A post-hoc analysis of two prospective observational studies. J Crit Care 2024; 79:154439. [PMID: 37832351 DOI: 10.1016/j.jcrc.2023.154439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 09/20/2023] [Accepted: 09/22/2023] [Indexed: 10/15/2023]
Abstract
PURPOSE Several initiatives have recently focused on raising awareness about limitations of treatment in Poland. We aimed to assess if the propensity to limit LST among elderly patients in 2018-2019 increased compared to 2016-2017. METHODS We analysed Polish cohorts from studies VIP1 (October 2016 - May 2017) and VIP2 (May 2018 - May 2019) that enrolled critical patients aged >80. We collected data on demographics, clinical features limitations of LST. Primary analysis assessed factors associated with prevalence of limitations of LST, A secondary analysis explored differences between patients with and without limitations of LST. RESULTS 601 patients were enrolled. Prevalence of LST limitations was 16.1% in 2016-2017 and 20.5% in 2018-2019. No difference was found in univariate analysis (p = 0.22), multivariable model showed higher propensity towards limiting LST in the 2018-2019 cohort compared to 2016-2017 cohort (OR 1.07;95%CI, 1.01-1.14). There was higher mortality and a longer length of stay of patients with limitations of LST compared to the patients without limitations of LST. (11 vs. 6 days, p = 0.001). CONCLUSIONS The clinicians in Poland have become more proactive in limiting LST in critically ill patients ≥80 years old over the studied period, however the prevalence of limitations of LST in Poland remains low.
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Affiliation(s)
- Paweł Pasieka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
| | - Anna Surówka
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Jakub Fronczek
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Evan Skwara
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Czuczwar
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Michał Borys
- 2nd Department of Anaesthesiology and Intensive Care Medical University of Lublin, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Kraków, Poland; 2nd Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland
| | - Łukasz R Nowak
- Department of Intensive Care and Anaesthesiology, 5(th) Military Clinical Hospital in Kraków, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Center in Lubin, Poland
| | - Jacek Skowronek
- St. Raphael Hospital, Department of Anaesthesiology and Intensive Care, Kraków, Poland
| | - Joanna Solek-Pastuszka
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anesthesiology and Intensive Therapy PUM, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Paweł Grudzień
- Department of Anaesthesiology and Intensive Therapy, E. Szczeklik Specialist Hospital in Tarnów, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Kraków, Poland; Department of Anaesthesiology and Intensive Care, St Ann Hospital in Miechów, Poland
| | - Natalia Popek
- Department of Anaesthesiology and Intensive Therapy, S. Żeromski Specialist Hospital in Kraków, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland; Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialized Hospital in Kraków, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland; Department of Anaesthesiology and Intensive Care, St John Grande Hospital in Kraków, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy - Centre for Artificial Extracorporeal Kidney and Liver Support, The Dr Wł. Biegański Regional Specialist Hospital in Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdańsk, Poland
| | - Małgorzata Szymkowiak
- Department of Anaesthesiology and Intensive Care, Provincial Hospital in Poznań, Poland
| | - Ryszard Gawda
- Department of Anesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wrocław Medical University, Wrocław, Poland
| | - Barbara Adamik
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Waldemar Goździk
- Clinical Department of Anesthesiology and Intensive Therapy, Wroclaw Medical University, Poland
| | - Agnieszka Wieczorek
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Jarosław Janc
- Anaesthesia and Intensive Care Unit, 4(th) Military Hospital in Wrocław, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland; Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Janusz Trzebicki
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Paweł Zatorski
- University Clinical Center of the Medical University of Warsaw - Infant Jesus Clinical Hospital, I Department of Anaesthesiology and Intensive Care, Warsaw, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1st Depratment of Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Kraków, Poland; Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Kraków University, Kraków, Poland
| | - Lukasz J Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Center, School of Medicine in Katowice - Medical University of Silesia, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Therapy, Medical Unibersity of Białystok, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Góra, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Norway
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
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Toyama M, Mori H, Kuriyama A, Sano M, Imura H, Nishimura M, Nakayama T. Challenges of using body bags for COVID-19 deaths from the healthcare provider perspective - a qualitative study. BMJ Open Qual 2024; 13:e002548. [PMID: 38290757 PMCID: PMC10828837 DOI: 10.1136/bmjoq-2023-002548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 01/10/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND During the COVID-19 pandemic, numerous issues regarding end-of-life care for COVID-19 patients have been discussed. Among these issues, challenges related to the use of body bags following the death of COVID-19 patients have been suggested. This study aimed to identify the challenges faced by healthcare professionals (HCPs) when using body bags after the death of patients infected with COVID-19 in medical settings. METHODS We conducted a qualitative descriptive study with semistructured in-depth interviews using inductive thematic analysis. From August to December 2021, we interviewed nurses and doctors who provided end-of-life care to COVID-19 patients focusing on their experiences with the use of body bags for the deceased. RESULTS Of the 25 interviewees who mentioned body bag use, 14 were nurses (56%) and 13 were women (52%). The mean interview length was 52.0 min (SD 9.6 min). Challenges associated with body bag use were classified into four themes with eight categories: preserving the dignity of the deceased, consideration for the bereaved saying a final goodbye to a loved one in a body bag, the physical and emotional impact on HCPs, and diverse opinions on body bag use. CONCLUSION Our findings include ethical concerns about the dignity of the deceased, empathy for the grief of bereaved families, and the emotional and physical distress experienced by HCPs struggling with the recommendation to use body bags based on limited evidence. The diverse perspectives of HCPs in this study highlight potential issues that developers should consider when formulating more appropriate and acceptable guidelines/guidance and policies.
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Affiliation(s)
- Mayumi Toyama
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Hiroko Mori
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Section of Epidemiology, Shizuoka Graduate University of Public Health, Shizuoka, Japan
| | - Akira Kuriyama
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Makiko Sano
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
- Department of Nursing, School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Haruki Imura
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Mayumi Nishimura
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University Graduate School of Medicine and Public Health, Kyoto, Japan
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Pasieka PM, Kurek M, Skupnik W, Skwara E, Bezshapkin V, Fronczek J, Kluzik A, Kudliński B, Białka S, Studzińska D, Krzych ŁJ, Czajka S, Stefaniak J, Owczuk R, Sołek-Pastuszka J, Biernawska J, Zorska J, Krawczyk P, Cwyl K, Żukowski M, Kotfis K, Zegan-Barańska M, Wieczorek A, Mudyna W, Piechota M, Bernas S, Machała W, Sadowski Ł, Serwa M, Czuczwar M, Borys M, Ziętkiewicz M, Kozera N, Adamik B, Goździk W, Nasiłowski P, Zatorski P, Trzebicki J, Gałkin P, Gawda R, Kościuczuk U, Cyrankiewicz W, Sierakowska K, Gola W, Hymczak H, Flaatten H, Szczeklik W. Predictors of outcomes of patients ≥ 80 years old admitted to intensive care units in Poland - a post-hoc analysis of the VIP2 prospective observational study. Anaesthesiol Intensive Ther 2024; 56:61-69. [PMID: 38741445 PMCID: PMC11022638 DOI: 10.5114/ait.2024.138192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 01/24/2024] [Indexed: 05/16/2024] Open
Abstract
INTRODUCTION Elderly patients pose a significant challenge to intensive care unit (ICU) clinicians. In this study we attempted to characterise the population of patients over 80 years old admitted to ICUs in Poland and identify associations between clinical features and short-term outcomes. MATERIAL AND METHODS The study is a post-hoc analysis of the Polish cohort of the VIP2 European prospective observational study enrolling patients > 80 years old admitted to ICUs over a 6-month period. Data including clinical features, clinical frailty scale (CFS), geriatric scales, interventions within the ICU, and outcomes (30-day and ICU mortality and length of stay) were gathered. Univariate analyses comparing frail (CFS > 4) to non-frail patients and survivors to non-survivors were performed. Multivariable models with CFS, activities of daily living score (ADL), and the cognitive decline questionnaire IQCODE as predictors and ICU or 30-day mortality as outcomes were formed. RESULTS A total of 371 patients from 27 ICUs were enrolled. Frail patients had significantly higher ICU (58% vs. 44.45%, P = 0.03) and 30-day (65.61% vs. 54.14%, P = 0.01) mortality compared to non-frail counterparts. The survivors had significantly lower SOFA score, CFS, ADL, and IQCODE than non-survivors. In multivariable analysis CFS (OR 1.15, 95% CI: 1.00-1.34) and SOFA score (OR 1.29, 95% CI: 1.19-1.41) were identified as significant predictors for ICU mortality; however, CFS was not a predictor for 30-day mortality ( P = 0.07). No statistical significance was found for ADL, IQCODE, polypharmacy, or comorbidities. CONCLUSIONS We found a positive correlation between CFS and ICU mortality, which might point to the value of assessing the score for every patient admitted to the ICU. The older Polish ICU patients were characterised by higher mortality compared to the other European countries.
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Affiliation(s)
- Paweł Melchior Pasieka
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Kurek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Skupnik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Evan Skwara
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Valentyn Bezshapkin
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Jakub Fronczek
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Anna Kluzik
- Department of Anaesthesiology, Intensive Therapy and Pain Treatment, Poznan University of Medical Sciences, Poznan, Poland
- Department of Teaching Anaesthesiology and Intensive Therapy, Poznan University of Medical Sciences, Poznan, Poland
| | - Bartosz Kudliński
- Clinical Department of Anaesthesiology and Intensive Care, University Hospital in Zielona Gora, Poland
| | - Szymon Białka
- Department of Anaesthesiology and Critical Care, School of Medicine with Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Dorota Studzińska
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
- Department of Anaesthesiology and Intensive Care, St. John Grande Hospital in Krakow, Poland
| | - Łukasz J. Krzych
- Department of Anaesthesiology and Intensive Care, University Clinical Centre, School of Medicine in Katowice – Medical University of Silesia, Katowice, Poland
| | - Szymon Czajka
- Department of Anaesthesiology and Intensive Care, University Clinical Centre, School of Medicine in Katowice – Medical University of Silesia, Katowice, Poland
| | - Jan Stefaniak
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Radosław Owczuk
- Department of Anaesthesiology and Intensive Therapy, Faculty of Medicine, Medical University of Gdansk, Poland
| | - Joanna Sołek-Pastuszka
- Department of Clinical Anaesthesiology and Intensive Therapy, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Jowita Biernawska
- Department of Clinical Anaesthesiology and Intensive Therapy, Pomeranian Medical University SPSK 1, Szczecin, Poland
| | - Joanna Zorska
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Paweł Krawczyk
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Katarzyna Cwyl
- Anesthesia and Intensive Care Unit, Regional Health Centre in Lublin, Poland
| | - Maciej Żukowski
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Katarzyna Kotfis
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | - Małgorzata Zegan-Barańska
- Department of Anaesthesiology, Intensive Therapy and Acute Intoxications, Pomeranian Medical University in Szczecin, Poland
| | | | - Wojciech Mudyna
- Department of Anaesthesiology and Intensive Therapy, Ludwik Rydygier Memorial Specialist Hospital in Krakow, Poland
| | - Mariusz Piechota
- Department of Anaesthesiology and Intensive Therapy – Centre for Artificial Extracorporeal Kidney and Liver Support, Lodz, Poland
| | - Szymon Bernas
- Department of Anaesthesiology and Intensive Therapy – Centre for Artificial Extracorporeal Kidney and Liver Support, Lodz, Poland
| | - Waldemar Machała
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Łukasz Sadowski
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Marta Serwa
- Department of Anaesthesiology and Intensive Therapy, Central Teaching Hospital of the Medical University of Lodz, Poland
| | - Mirosław Czuczwar
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Michał Borys
- 2 Department of Anaesthesiology and Intensive Care, Medical University of Lublin, Poland
| | - Mirosław Ziętkiewicz
- Department of Anaesthesiology and Intensive Care Medicine, Jagiellonian University Medical College, Krakow, Poland
- 2 Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Krakow, Poland
| | - Natalia Kozera
- Department of Anaesthesiology and Intensive Therapy, Wroclaw University Hospital, Wroclaw Medical University, Wroclaw, Poland
| | - Barbara Adamik
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Waldemar Goździk
- Clinical Department of Anaesthesiology and Intensive Therapy, Wroclaw Medical University, Wroclaw, Poland
| | - Paweł Nasiłowski
- Department of Anaesthesiology and Intensive Therapy, G. Narutowicz Specialist Hospital in Krakow, Poland
- Department of Anaesthesiology and Intensive Care, St. Ann Hospital in Miechow, Poland
| | - Paweł Zatorski
- I Department of Anaesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw – Infant Jesus Clinical Hospital, Warsaw, Poland
| | - Janusz Trzebicki
- I Department of Anaesthesiology and Intensive Care, University Clinical Center of the Medical University of Warsaw – Infant Jesus Clinical Hospital, Warsaw, Poland
| | - Piotr Gałkin
- Department of Anaesthesiology and Intensive Care, Regional Hospital in Bialystok, Poland
| | - Ryszard Gawda
- Department of Anaesthesiology and Intensive Care, Institute of Medical Sciences, University of Opole, Poland
| | - Urszula Kościuczuk
- Department of Anaesthesiology and Intensive Care, Medical University of Bialystok, Poland
| | - Waldemar Cyrankiewicz
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
| | - Katarzyna Sierakowska
- Department of Anaesthesiology and Intensive Therapy, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland
- Department of Anaesthesiology and Intensive Therapy, Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum, Bydgoszcz, Poland
| | - Wojciech Gola
- Faculty of Medicine and Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Hubert Hymczak
- 1 Department of Anaesthesiology and Intensive Care, John Paul II Hospital in Krakow, Poland
- Faculty of Medicine and Health Sciences, Andrzej Frycz Modrzewski Krakow University, Krakow, Poland
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care, Haukeland University Hospital, Bergen, Norway
| | - Wojciech Szczeklik
- Centre for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
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Syrous AN, Gudnadottir G, Oras J, Ferguson T, Lilja D, Odenstedt Herges H, Larsson E, Block L. End-of-life decision-making in critically ill old patients with and without coronavirus disease 2019. Acta Anaesthesiol Scand 2024; 68:63-70. [PMID: 37670491 DOI: 10.1111/aas.14326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 07/29/2023] [Accepted: 08/17/2023] [Indexed: 09/07/2023]
Abstract
BACKGROUND There are few studies on the differences in end-of-life decisions making in critically ill patients with and without coronavirus disease 2019 (COVID-19). This study aimed to investigate the independent factors that predicted the decision to withdraw or withhold life-sustaining treatments (LST) in critically ill patients and if these decisions were based on different variables for critically ill patients with COVID-19 compared to those for critically ill patients with other diagnoses in a Swedish intensive care unit. METHODS This observational pilot study was performed at Sahlgrenska University Hospital, Gothenburg, Sweden. Patients ≥65 years were included from 1 March 2020 to 30 April 2021. The association between a decision to limit LST and a priori selected variables including sex, age, Simplified Acute Physiology Score 3 (SAPS 3), Clinical Frailty Scale ≥4, Charlson Comorbidity Index, Body Mass Index, living at home, invasive and non-invasive mechanical ventilation was assessed using a univariate and multivariable logistic regression model and presented as odds ratio with corresponding 95% confidence intervals. RESULTS There were 394 patients included in this study, 131 in the non-COVID-19 group and 263 in the COVID-19 group. For the non-COVID-19 cohort, the univariate analysis demonstrated that age and SAPS 3 were significantly associated with the decision to withdraw or withhold life-sustaining treatments, and this association remained in the multivariable analysis, with odds ratios of 1.10 (1.03-1.19) p = .009 and 1.06 (1.03-1.10) p < .001, respectively. For the COVID-19 cohort, the univariate analysis indicated that age, SAPS 3, and Charlson comorbidity index were significantly associated with the decision to withdraw or withhold life-sustaining treatments. However, in multivariable analysis, only the Charlson comorbidity index remained independently associated with the decision to withdraw or withhold life-sustaining treatments, with an odds ratio of 1.26 (1.07-1.49), p = .006. CONCLUSION Decisions to withdraw or withhold life-sustaining treatments were based on other variables for the critically ill COVID-19 cohort compared to those for the critically ill non-COVID-19 cohort. Further studies are warranted to forge a common path for ethical end-of-life decision-making in critically ill patients.
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Affiliation(s)
- Alma Nordenskjöld Syrous
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gudny Gudnadottir
- Section of Geriatrics, Department of Acute Medicine and Geriatrics, Sahlgrenska University Hospital, Gothenburg, Sweden
- Center for Aging and Health AgeCAP, University of Gothenburg, Gothenburg, Sweden
| | - Jonatan Oras
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, Gothenburg, Sweden
| | - Thalia Ferguson
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, Gothenburg, Sweden
| | - David Lilja
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, Gothenburg, Sweden
| | - Helena Odenstedt Herges
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, Gothenburg, Sweden
| | - Emma Larsson
- Preoperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Linda Block
- Department of Anaesthesiology and Intensive Care, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Department of Anaesthesiology and Intensive Care, Gothenburg, Sweden
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5
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Beil M, van Heerden PV, Joynt GM, Lapinsky S, Flaatten H, Guidet B, de Lange D, Leaver S, Jung C, Forte DN, Bin D, Elhadi M, Szczeklik W, Sviri S. Limiting life-sustaining treatment for very old ICU patients: cultural challenges and diverse practices. Ann Intensive Care 2023; 13:107. [PMID: 37884827 PMCID: PMC10603016 DOI: 10.1186/s13613-023-01189-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND Decisions about life-sustaining therapy (LST) in the intensive care unit (ICU) depend on predictions of survival as well as the expected functional capacity and self-perceived quality of life after discharge, especially in very old patients. However, prognostication for individual patients in this cohort is hampered by substantial uncertainty which can lead to a large variability of opinions and, eventually, decisions about LST. Moreover, decision-making processes are often embedded in a framework of ethical and legal recommendations which may vary between countries resulting in divergent management strategies. METHODS Based on a vignette scenario of a multi-morbid 87-year-old patient, this article illustrates the spectrum of opinions about LST among intensivsts with a special interest in very old patients, from ten countries/regions, representing diverse cultures and healthcare systems. RESULTS This survey of expert opinions and national recommendations demonstrates shared principles in the management of very old ICU patients. Some guidelines also acknowledge cultural differences between population groups. Although consensus with families should be sought, shared decision-making is not formally required or practised in all countries. CONCLUSIONS This article shows similarities and differences in the decision-making for LST in very old ICU patients and recommends strategies to deal with prognostic uncertainty. Conflicts should be anticipated in situations where stakeholders have different cultural beliefs. There is a need for more collaborative research and training in this field.
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Affiliation(s)
- Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Peter Vernon van Heerden
- General Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Gavin M Joynt
- Department of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Stephen Lapinsky
- Intensive Care Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Hans Flaatten
- Department of Research and Development, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint Antoine, Service MIR, Sorbonne Université, Paris, France
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
| | - Daniel Neves Forte
- Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Du Bin
- Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China
| | | | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Ul. Wrocławska 1-3, 30 - 901, Kraków, Poland.
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Ul Hassan SS, Ali W, Khan H, Raja AR, Hassan M, Haque G, Ayub F, Waqar MA, Latif A. Confronted With Death: Factors Affecting End of Life Decisions in the Intensive Care Unit. OMEGA-JOURNAL OF DEATH AND DYING 2023:302228231198360. [PMID: 37632273 DOI: 10.1177/00302228231198360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2023]
Abstract
To determine how often care is limited at the end of life and the factors that are associated with this decision, we reviewed the medical records of all patients that passed away in the intensive care units (ICU) of Aga Khan University. We found that a majority of patients had Do-Not-Resuscitate orders in place at the time of death. Our analysis yielded 6 variables that were associated with the decision to limit care. These are patient age, sex, duration of mechanical ventilation, Glasgow Coma Scale (GCS) ≤8 at any point during ICU stay, GCS ≤8 in the first 24 hours following ICU admission, and mean arterial pressure <65 mm of Hg while on vasopressors in the first 24 hours following ICU admission. These variables require further study and should be carefully considered during end of life discussions to allow for optimal management at the end of life.
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Affiliation(s)
| | - Wajid Ali
- Dean's Clinical Research Fellow, Aga Khan University, Karachi, Pakistan
| | - Hamza Khan
- Dean's Clinical Research Fellow, Aga Khan University, Karachi, Pakistan
| | | | | | - Ghazal Haque
- Centre for Patient Safety, Aga Khan University, Karachi, Pakistan
| | - Farwa Ayub
- Centre for Patient Safety, Aga Khan University, Karachi, Pakistan
| | | | - Asad Latif
- Centre for Patient Safety, Aga Khan University, Karachi, Pakistan
- Department of Anesthesiology, Aga Khan University Hospital, Karachi, Pakistan
- Armstrong Institute for Patient Safety and Quality, Johns Hopkins Medicine, Baltimore, USA
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7
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Skei NV, Nilsen TIL, Knoop ST, Prescott H, Lydersen S, Mohus RM, Brkic A, Liyanarachi KV, Solligård E, Damås JK, Gustad LT. Long-term temporal trends in incidence rate and case fatality of sepsis and COVID-19-related sepsis in Norwegian hospitals, 2008-2021: a nationwide registry study. BMJ Open 2023; 13:e071846. [PMID: 37532480 PMCID: PMC10401253 DOI: 10.1136/bmjopen-2023-071846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/04/2023] Open
Abstract
OBJECTIVES To estimate temporal trends in incidence rate (IR) and case fatality during a 14-year period from 2008 to 2021, and to assess possible shifts in these trends during the COVID-19 pandemic. SETTING All Norwegian hospitals 2008-2021. PARTICIPANTS 317 705 patients ≥18 year with a sepsis International Classification of Diseases 10th revision code retrieved from The Norwegian Patient Registry. PRIMARY AND SECONDARY MEASURES Annual age-standardised IRs with 95% CIs. Poisson regression was used to estimate changes in IRs across time, and logistic regression was used to estimate ORs for in-hospital death. RESULTS Among 12 619 803 adult hospitalisations, a total of 317 705 (2.5%) hospitalisations in 222 832 (70.0%) unique patients met the sepsis criteria. The overall age-standardised IR of a first sepsis admission was 246/100 000 (95% CI 245 to 247), whereas the age-standardised IR of all sepsis admissions was 352/100 000 (95% CI 351 to 354). In the period 2009-2019, the annual IR for a first sepsis episode was stable (IR ratio (IRR) per year, 0.999; 95% CI 0.994 to 1.004), whereas for recurrent sepsis the IR increased (annual IRR, 1.048; 95% CI 1.037 to 1.059). During the COVID-19 pandemic, the IRR for a first sepsis was 0.877 (95% CI 0.829 to 0.927) in 2020 and 0.929 (95% CI 0.870 to 0.992) in 2021, and for all sepsis it was 0.870 (95% CI 0.810 to 0.935) in 2020 and 0.908 (95% CI 0.840 to 0.980) in 2021, compared with the previous 11-year period. Case fatality among first sepsis admissions declined in the period 2009-2019 (annual OR 0.954 (95% CI 0.950 to 0.958)), whereas case fatality increased during the COVID-19 pandemic in 2020 (OR 1.061 (95% CI 1.001 to 1.124) and in 2021 (OR 1.164 (95% CI 1.098 to 1.233)). CONCLUSION The overall IR of sepsis increased from 2009 to 2019, due to an increasing IR of recurrent sepsis, and indicates that sepsis awareness with updated guidelines and education must continue.
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Affiliation(s)
- Nina Vibeche Skei
- Department of Anesthesia and Intensive Care, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Siri Tandberg Knoop
- Department of Microbiology, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Hallie Prescott
- Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
- VA Center for Clinical Management Research, HSR&D Center of Innovation, Ann Arbor, Michigan, USA
| | - Stian Lydersen
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Randi Marie Mohus
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Clinic of Anaesthesia and Intensive Care, St Olavs Hospital Trondheim University Hospital, Trondheim, Norway
| | - Alen Brkic
- Research Department, Sørlandet Sykehus HF, Kristiansand, Norway
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Kristin Vardheim Liyanarachi
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway
| | - Erik Solligård
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Jan Kristian Damås
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Infectious Diseases, St. Olav's University Hospital, Trondheim, Norway
- Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lise Tuset Gustad
- Institute of Circulation and Medical Imaging, Mid-Norway Centre of Sepsis Research, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Department of Medicine and Rehabilitation, Nord-Trondelag Hospital Trust, Levanger, Norway
- Faculty of Nursing and Health Sciences, Nord University, Levanger, Norway
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8
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Erkens R, Duse D, Wernly B, Flaatten H, Fjølner J, Bruno RR, Wolff G, Artigas A, Kelm M, Beil M, Sviri S, Schaller SJ, Fuest K, Szczeklik W, Piayda K, Elhadi M, Joannidis M, Nedergaard HK, Oeyen S, Moreno R, Leaver S, de Lange DW, Guidet B, Jung C. Associations of anemia and blood transfusions with mortality in old, critically ill COVID-19 patients - Results from the prospective COVIP Study. Clin Hemorheol Microcirc 2023; 84:309-320. [PMID: 37248892 DOI: 10.3233/ch-231790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
AIMS Anemia is common in the old and often observed in critically ill patients. Increased age is associated with higher mortality following a COVID-19 infection, making old patients prone to poor outcomes. We investigated whether anemia at admission to the ICU or the need for blood transfusion was associated with 90-day mortality in older, critically ill COVID-19 patients. METHODS In this prospective multicenter study, the 90-day mortality of COVID-19 patients≥70 years treated in 138 intensive care units (ICU) was analyzed. Associations between anemia (WHO definition) at admission and discharge from ICU and the use of red blood cell (RBC) transfusions with mortality were assessed. Hemoglobin thresholds of RBC transfusions in old, critically ill COVID-19 patients were recorded. RESULTS In 493 patients (350 anemic, 143 non-anemic), anemia (WHO definition) at the time of ICU admission was not associated with impaired overall survival. Transfusion and severe anemia (hemoglobin≤10 g/dL) at ICU discharge were independently associated with a higher risk of 90-day mortality. CONCLUSION The need for red blood cell transfusions and severe anemia at ICU discharge, but not at the timepoint of admission, were independently associated with 90-day mortality in critically-ill old COVID-19 patients.
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Affiliation(s)
- Ralf Erkens
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Dragos Duse
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Bernhard Wernly
- Department of Cardiology, Paracelsus Medical University, Salzburg, Austria
| | - Hans Flaatten
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Raphael Romano Bruno
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Georg Wolff
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Antonio Artigas
- Department of Intensive Care Medicine, Parc Tauli Hospital Universitari, Institut d'Investigació I Innovacio Par tauli (I3PT-CERCA), CIBER Enfermedades Respiratorias, Autonomous University of Barcelona, Barcelona, Spain
| | - Malte Kelm
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
- CARID (Cardiovascular Research Institute Düsseldorf), Düsseldorf, Germany
| | - Michael Beil
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah University Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Stefan J Schaller
- Department of Anesthesiology and Operative Intensive Care Medicine (CVK, CCM), Charitè-Universitätsmedizin Berlin, Freie Universiätt Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Kristina Fuest
- Klinikum Rechts der Isar, Department of Anaesthesiology & Intensive Care Medicine, School of Medicine, Technical University Munich, Munich, Germany
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Kerstin Piayda
- Department of Cardiology and Angiology, Universitätsklinikum Gießen und Marburg, Gießen, Germany
| | | | - Michael Joannidis
- Division of Intensive Care and Emergency Medicine, Department of Internal Medicine, Medical University Innsbruck, Innsbruck, Austria
| | - Helene Korvenius Nedergaard
- Department of Anesthesiology and Intensive Care, University Hospital of Southern Denmark, Kolding, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Sandra Oeyen
- Department of Intensive Care 1K12IC, Ghent University Hospital, Ghent, Belgium
| | - Rui Moreno
- Unidade de Cuidados Intensivos Neurocríticos e Trauma, Hospital de São José, Centro Hospitalar Universitério de Lisboa Central, Faculdade de Ciências Médicas de Lisboa, Nova Médical School, Lisbon, Portugal
| | - Susannah Leaver
- General Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Dylan W de Lange
- Department of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Bertrand Guidet
- Sorbonne Universités, UPMC Univ Paris 06, INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Equipe: Épidémiologie Hospitalière Qualité et Organisation des Soins, Paris, France
- Assistance Publique -Hôpitaux de Paris, Hôpital Saint-Antoine, Service de Réanimation Médicale,, Paris, France
| | - Christian Jung
- Division of Cardiology, Pulmonology and Vascular Medicine, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
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