5 research outputs found
Limitation of life support techniques at admission to the intensive care unit : A multicenter prospective cohort study
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. 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. 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. The frequency of ICU admission with LLST is low but probably increasing; nearly one third of these patients survive for ℠30 days
Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study
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 hospitalsâ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial model) and patientsâ 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 62.5â±â16.1 years). Most ICUs (94.8%) admitted patients with LLST, but only 238 (7.8% [95% CI 7.0â8.8]) patients had LLST on ICU admission; this group had higher ICU mortality (44.5 vs. 9.4% in patients without LLST; pâ<â0.001). Multilevel logistic regression showed a contextual effect of the hospital in LLST on ICU admission (median ORâ=â2.30 [95% CI 1.59â2.96]) 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 31.7â44.5). 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 â„â30 days
Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study
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 hospitalsâ characteristics (availability of intermediate care units, usual availability of ICU beds, and financial
model) and patientsâ 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 7.0â8.8]) 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 1.59â2.96]) 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 31.7â44.5). 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 â„ 30 days
Additional file 1: of Limitation of life support techniques at admission to the intensive care unit: a multicenter prospective cohort study
Table S1. Hospital characteristics. Table S2. Patient characteristics. Table S3. Reasons for limitations on life support at admission to the ICU. Table S4. Bivariate analysis. Patient characteristics associated with LLST. Crude odds ratio (OR) and 95% confidence interval. Table S5. Bivariate analysis. Hospital characteristics associated with LLST. Crude odds ratio (OR) and 95% confidence interval. Figure S1. Thirty-day overall survival function according to the specific support measures limited and the type of limitation. (RTF 56201Â kb