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Lacerda FH, Checoli PG, Silva CMDD, Brandão CE, Forte DN, Besen BAMP. Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit. Rev Bras Ter Intensiva 2020; 32:528-534. [PMID: 33470354 PMCID: PMC7853674 DOI: 10.5935/0103-507x.20200090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022] Open
Abstract
Objective To describe the characteristics and outcomes of patients undergoing mechanical ventilation withdrawal and to compare them to mechanically ventilated patients with limitations (withhold or withdrawal) of life-sustaining therapies but who did not undergo mechanical ventilation withdrawal. Methods This was a retrospective cohort study from January 2014 to December 2018 of mechanically ventilated patients with any organ support limitation admitted to a single intensive care unit. We compared patients who underwent mechanical ventilation withdrawal and those who did not regarding intensive care unit and hospital mortality and length of stay in both an unadjusted analysis and a propensity score matched subsample. We also analyzed the time from mechanical ventilation withdrawal to death. Results Out of 282 patients with life-sustaining therapy limitations, 31 (11%) underwent mechanical ventilation withdrawal. There was no baseline difference between groups. Intensive care unit and hospital mortality rates were 71% versus 57% and 93% versus 80%, respectively, among patients who underwent mechanical ventilation withdrawal and those who did not. The median intensive care unit length of stay was 7 versus 8 days (p = 0.6), and the hospital length of stay was 9 versus 15 days (p = 0.015). Hospital mortality was not significantly different (25/31; 81% versus 29/31; 93%; p = 0.26) after matching. The median time from mechanical ventilation withdrawal until death was 2 days [0 - 5], and 10/31 (32%) patients died within 24 hours after mechanical ventilation withdrawal. Conclusion In this Brazilian report, mechanical ventilation withdrawal represented 11% of all patients with treatment limitations and was not associated with increased hospital mortality after propensity score matching on relevant covariates.
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Affiliation(s)
- Fábio Holanda Lacerda
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, AC Camargo Cancer Center - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital OTOclínica - Fortaleza (CE), Brasil
| | - Pedro Garcia Checoli
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Carla Marchini Dias da Silva
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, AC Camargo Cancer Center - São Paulo (SP), Brasil
| | - Carlos Eduardo Brandão
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, AC Camargo Cancer Center - São Paulo (SP), Brasil
| | - Daniel Neves Forte
- Programa de Cuidados Paliativos, Hospital Sírio-Libanês - São Paulo (SP), Brasil
| | - Bruno Adler Maccagnan Pinheiro Besen
- Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil.,Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, Brasil
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4
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Ramos JGR, Tourinho FC, Borrione P, Azi P, Andrade T, Costa V, Reis Z, Batista PBP, Mendes AV. Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis. Rev Bras Ter Intensiva 2018; 30:308-316. [PMID: 30183975 PMCID: PMC6180461 DOI: 10.5935/0103-507x.20180042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 03/28/2018] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE To assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations. METHODS Data were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program. RESULTS We analyzed 48,372 hospital admissions and 1,071 in-hospital deaths. Deaths were preceded by do-not-resuscitate orders in 276 (25.8%) cases and admissions to the intensive care unit occurred in 814 (76%) cases. Do-not-resuscitate orders increased from 125 (20.4%) to 151 (33%) cases in the pre-implementation and post-implementation periods, respectively (p < 0.001). Intensive care unit admissions occurred in 469 (76.5%) and 345 (75.3%) cases in the pre-implementation and post-implementation periods, respectively (p = 0.654). Interrupted time series analyses confirmed a trend of increased do-not-resuscitate order registrations, from an increase of 0.5% per month pre-implementation to an increase of 2.9% per month post-implementation (p < 0.001), and demonstrated a trend of decreased intensive care unit utilization, from an increase of 0.6% per month pre-implementation to a decrease of -0.9% per month in the post-implementation period (p = 0.001). CONCLUSION The implementation of a palliative care program was associated with a trend of increased registration of do-not-resuscitate orders and a trend of decreased intensive care unit utilization during terminal hospitalizations.
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Affiliation(s)
| | | | | | - Paula Azi
- Hospital São Rafael - Salvador (BA), Brasil
| | | | | | - Zan Reis
- Hospital São Rafael - Salvador (BA), Brasil
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5
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Rubio O, Arnau A, Cano S, Subirà C, Balerdi B, Perea ME, Fernández-Vivas M, Barber M, Llamas N, Altaba S, Prieto A, Gómez V, Martin M, Paz M, Quesada B, Español V, Montejo JC, Gomez JM, Miro G, Xirgú J, Ortega A, Rascado P, Sánchez JM, Marcos A, Tizon A, Monedero P, Zabala E, Murcia C, Torrejon I, Planas K, Añon JM, Hernandez G, Fernandez MDM, Guía C, Arauzo V, Perez JM, Catalan R, Gonzalez J, Poyo R, Tomas R, Saralegui I, Mancebo J, Sprung C, Fernández R. Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study. J Intensive Care 2018; 6:24. [PMID: 29686878 PMCID: PMC5899386 DOI: 10.1186/s40560-018-0283-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Accepted: 02/19/2018] [Indexed: 12/03/2022] Open
Abstract
Purpose To determine the frequency of limitations on life support techniques (LLSTs) on admission to intensive care units (ICU), factors associated, and 30-day survival in patients with LLST on ICU admission. Methods This prospective observational study included all patients admitted to 39 ICUs in a 45-day period in 2011. We recorded hospitals’ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patients’ characteristics (demographics, reason for admission, functional status, risk of death, and LLST on ICU admission (withholding/withdrawing; specific techniques affected)). The primary outcome was 30-day survival for patients with LLST on ICU admission. Statistical analysis included multilevel logistic regression models. Results We recruited 3042 patients (age 62.5 ± 16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0–8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; p < 0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median OR = 2.30 [95% CI 1.59–2.96]) and identified the following patient-related variables as independent factors associated with LLST on ICU admission: age, reason for admission, risk of death, and functional status. In patients with LLST on ICU admission, 30-day survival was 38% (95% CI 31.7–44.5). Factors associated with survival were age, reason for admission, risk of death, and number of reasons for LLST on ICU admission. Conclusions The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ≥ 30 days. Electronic supplementary material The online version of this article (10.1186/s40560-018-0283-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Olga Rubio
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | - Anna Arnau
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | - Sílvia Cano
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | - Carles Subirà
- Hospital Sant Joan De Déu, Fundació Althaia Xarxa Universitaria de Manresa, C/ Dr. Joan Soler s. n., 08243 Manresa, Spain
| | | | | | | | | | | | - Susana Altaba
- Hospital Universitario de Castellon, Castellon de la Plana, Spain
| | - Ana Prieto
- 8Hospital Rio Hortega, Valladolid, Spain
| | | | - Mar Martin
- 10Hospital Candelaria de Tenerife, Santa Cruz de Tenerife, Spain
| | - Marta Paz
- 11Hospital Clínico Universitario de Salamanca, Salamanca, Spain
| | | | | | | | | | | | | | - Ana Ortega
- 18Hospital Montecelo Pontevedra, Pontevedra, Spain
| | - Pedro Rascado
- 19Centro Hospitalario Universitario Santiago Compostela, Santiago de Compostela, Spain
| | | | | | - Ana Tizon
- 22Hospital Xeral Cíes Vigo, Vigo, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Rosa Poyo
- 36Hospital Son Llátzer, Palma, Spain
| | - Roser Tomas
- 37Hospital General de Catalunya, Sant Cugat del Valles, Spain
| | | | - Jordi Mancebo
- 39Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Charles Sprung
- 40Hadassh Hebrew University Medical Center, Jerusalem, Israel
| | - Rafael Fernández
- 41Hospital Sant Joan de Deu, Fundació Althaia Xarxa Universitaria de Manresa, Manresa, Spain
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Vincent F, Yaacoubi S, Bouguerba A, Ayed S, Bornstain C. Cardiopulmonary resuscitation in cancer patients: is there a problem? Support Care Cancer 2017; 25:2371-2372. [PMID: 28315962 DOI: 10.1007/s00520-017-3673-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 03/14/2017] [Indexed: 11/24/2022]
Affiliation(s)
- François Vincent
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France.
| | - Sondes Yaacoubi
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
| | - Abdelaziz Bouguerba
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
| | - Soufia Ayed
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
| | - Caroline Bornstain
- Polyvalent Intensive Care Unit, Groupe Hospitalier Intercommunal Le-Raincy Montfermeil, 10, Avenue du Général Leclerc, 93170, Montfermeil, France
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