Repository logo
 
Publication

Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016

2019-10-02Journal article Open access
Simple item page
dc.contributor.authorSprung, Charles L
dc.contributor.authorRicou, Bara
dc.contributor.authorHartog, Christiane S
dc.contributor.authorMaia, Paulo
dc.contributor.authorMentzelopoulos, Spyros D
dc.contributor.authorWeiss, Manfred
dc.contributor.authorLevin, Phillip D
dc.contributor.authorGalarza, Laura
dc.contributor.authorde la Guardia, Veronica
dc.contributor.authorSchefold, Joerg C
dc.contributor.authorBaras, Mario
dc.contributor.authorJoynt, Gavin M
dc.contributor.authorBülow, Hans-Henrik
dc.contributor.authorNakos, Georgios
dc.contributor.authorCerny, Vladimir
dc.contributor.authorMarsch, Stephan
dc.contributor.authorGirbes, Armand R
dc.contributor.authorIngels, Catherine
dc.contributor.authorMiskolci, Orsolya
dc.contributor.authorLedoux, Didier
dc.contributor.authorMullick, Sudakshina
dc.contributor.authorBocci, Maria G
dc.contributor.authorGjedsted, Jakob
dc.contributor.authorEstébanez, Belén
dc.contributor.authorNates, Joseph L
dc.contributor.authorLesieur, Olivier
dc.contributor.authorSreedharan, Roshni
dc.contributor.authorGiannini, Alberto M
dc.contributor.authorFuciños, Lucía Cachafeiro
dc.contributor.authorDanbury, Christopher M
dc.contributor.authorMichalsen, Andrej
dc.contributor.authorSoliman, Ivo W
dc.contributor.authorEstella, Angel
dc.contributor.authorAvidan, Alexander
dc.date.accessioned2020-05-22T17:34:33Z
dc.date.available2020-05-22T17:34:33Z
dc.date.issued2019-10-02
dc.description.abstractImportance: End-of-life decisions occur daily in intensive care units (ICUs) around the world, and these practices could change over time. Objective: To determine the changes in end-of-life practices in European ICUs after 16 years. Design, setting, and participants: Ethicus-2 was a prospective observational study of 22 European ICUs previously included in the Ethicus-1 study (1999-2000). During a self-selected continuous 6-month period at each ICU, consecutive patients who died or had any limitation of life-sustaining therapy from September 2015 until October 2016 were included. Patients were followed up until death or until 2 months after the first treatment limitation decision. Exposures: Comparison between the 1999-2000 cohort vs 2015-2016 cohort. Main outcomes and measures: End-of-life outcomes were classified into 5 mutually exclusive categories (withholding of life-prolonging therapy, withdrawing of life-prolonging therapy, active shortening of the dying process, failed cardiopulmonary resuscitation [CPR], brain death). The primary outcome was whether patients received any treatment limitations (withholding or withdrawing of life-prolonging therapy or shortening of the dying process). Outcomes were determined by senior intensivists. Results: Of 13 625 patients admitted to participating ICUs during the 2015-2016 study period, 1785 (13.1%) died or had limitations of life-prolonging therapies and were included in the study. Compared with the patients included in the 1999-2000 cohort (n = 2807), the patients in 2015-2016 cohort were significantly older (median age, 70 years [interquartile range {IQR}, 59-79] vs 67 years [IQR, 54-75]; P < .001) and the proportion of female patients was similar (39.6% vs 38.7%; P = .58). Significantly more treatment limitations occurred in the 2015-2016 cohort compared with the 1999-2000 cohort (1601 [89.7%] vs 1918 [68.3%]; difference, 21.4% [95% CI, 19.2% to 23.6%]; P < .001), with more withholding of life-prolonging therapy (892 [50.0%] vs 1143 [40.7%]; difference, 9.3% [95% CI, 6.4% to 12.3%]; P < .001), more withdrawing of life-prolonging therapy (692 [38.8%] vs 695 [24.8%]; difference, 14.0% [95% CI, 11.2% to 16.8%]; P < .001), less failed CPR (110 [6.2%] vs 628 [22.4%]; difference, -16.2% [95% CI, -18.1% to -14.3%]; P < .001), less brain death (74 [4.1%] vs 261 [9.3%]; difference, -5.2% [95% CI, -6.6% to -3.8%]; P < .001) and less active shortening of the dying process (17 [1.0%] vs 80 [2.9%]; difference, -1.9% [95% CI, -2.7% to -1.1%]; P < .001). Conclusions and relevance: Among patients who had treatment limitations or died in 22 European ICUs in 2015-2016, compared with data reported from the same ICUs in 1999-2000, limitations in life-prolonging therapies occurred significantly more frequently and death without limitations in life-prolonging therapies occurred significantly less frequently. These findings suggest a shift in end-of-life practices in European ICUs, but the study is limited in that it excluded patients who survived ICU hospitalization without treatment limitationspt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationSprung CL, Ricou B, Hartog CS, et al. Changes in End-of-Life Practices in European Intensive Care Units From 1999 to 2016 [published online ahead of print, 2019 Oct 2] [published correction appears in JAMA. 2019 Nov 5;322(17):1718]. JAMA. 2019;322(17):1‐12. doi:10.1001/jama.2019.14608pt_PT
dc.identifier.doi10.1001/jama.2019.14608pt_PT
dc.identifier.issn0098-7484
dc.identifier.issn1538-3598
dc.identifier.urihttp://hdl.handle.net/10400.16/2402
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherAmerican Medical Associationpt_PT
dc.relation.publisherversionhttps://jamanetwork.com/journals/jama/fullarticle/2752581pt_PT
dc.titleChanges in End-of-Life Practices in European Intensive Care Units From 1999 to 2016pt_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.conferencePlaceUnited States of Americapt_PT
oaire.citation.endPage12pt_PT
oaire.citation.issue17pt_PT
oaire.citation.startPage1pt_PT
oaire.citation.titleJAMApt_PT
oaire.citation.volume322pt_PT
person.familyNameMaia
person.givenNamePaulo
person.identifier.ciencia-id0018-24D5-3BB6
person.identifier.orcid0000-0003-4233-8475
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT
relation.isAuthorOfPublication3d48d1bf-6326-40bd-ad54-4eac888a2ce5
relation.isAuthorOfPublication.latestForDiscovery3d48d1bf-6326-40bd-ad54-4eac888a2ce5

Files

Original bundle
Now showing 1 - 1 of 1
Thumbnail Image
Name:
Changes in End-of-Life Practices in European Intensive Care.pdf
Size:
361.65 KB
Format:
Adobe Portable Document Format
Download

Collections

SCI1- Artigos publicados em revistas indexadas na Pubmed/Medline