Limitation of life-sustaining therapies in critically ill patients with COVID-19 : a descriptive epidemiological investigation from the COVID-ICU study
© 2023. The Author(s)..
BACKGROUND: Limitations of life-sustaining therapies (LST) practices are frequent and vary among intensive care units (ICUs). However, scarce data were available during the COVID-19 pandemic when ICUs were under intense pressure. We aimed to investigate the prevalence, cumulative incidence, timing, modalities, and factors associated with LST decisions in critically ill COVID-19 patients.
METHODS: We did an ancillary analysis of the European multicentre COVID-ICU study, which collected data from 163 ICUs in France, Belgium and Switzerland. ICU load, a parameter reflecting stress on ICU capacities, was calculated at the patient level using daily ICU bed occupancy data from official country epidemiological reports. Mixed effects logistic regression was used to assess the association of variables with LST limitation decisions.
RESULTS: Among 4671 severe COVID-19 patients admitted from February 25 to May 4, 2020, the prevalence of in-ICU LST limitations was 14.5%, with a nearly six-fold variability between centres. Overall 28-day cumulative incidence of LST limitations was 12.4%, which occurred at a median of 8 days (3-21). Median ICU load at the patient level was 126%. Age, clinical frailty scale score, and respiratory severity were associated with LST limitations, while ICU load was not. In-ICU death occurred in 74% and 95% of patients, respectively, after LST withholding and withdrawal, while median survival time was 3 days (1-11) after LST limitations.
CONCLUSIONS: In this study, LST limitations frequently preceded death, with a major impact on time of death. In contrast to ICU load, older age, frailty, and the severity of respiratory failure during the first 24 h were the main factors associated with decisions of LST limitations.
| Errataetall: |
CommentIn: Crit Care. 2023 May 22;27(1):195. - PMID 37218008 |
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| Medienart: |
E-Artikel |
| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:27 |
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| Enthalten in: |
Critical care (London, England) - 27(2023), 1 vom: 11. März, Seite 103 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Giabicani, Mikhael [VerfasserIn] |
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| Links: |
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| Themen: |
Acute respiratory distress syndrome |
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| Anmerkungen: |
Date Completed 14.03.2023 Date Revised 24.05.2023 published: Electronic CommentIn: Crit Care. 2023 May 22;27(1):195. - PMID 37218008 Citation Status MEDLINE |
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| doi: |
10.1186/s13054-023-04349-1 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM354122789 |
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| 245 | 1 | 0 | |a Limitation of life-sustaining therapies in critically ill patients with COVID-19 |b a descriptive epidemiological investigation from the COVID-ICU study |
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| 500 | |a Date Completed 14.03.2023 | ||
| 500 | |a Date Revised 24.05.2023 | ||
| 500 | |a published: Electronic | ||
| 500 | |a CommentIn: Crit Care. 2023 May 22;27(1):195. - PMID 37218008 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023. The Author(s). | ||
| 520 | |a BACKGROUND: Limitations of life-sustaining therapies (LST) practices are frequent and vary among intensive care units (ICUs). However, scarce data were available during the COVID-19 pandemic when ICUs were under intense pressure. We aimed to investigate the prevalence, cumulative incidence, timing, modalities, and factors associated with LST decisions in critically ill COVID-19 patients | ||
| 520 | |a METHODS: We did an ancillary analysis of the European multicentre COVID-ICU study, which collected data from 163 ICUs in France, Belgium and Switzerland. ICU load, a parameter reflecting stress on ICU capacities, was calculated at the patient level using daily ICU bed occupancy data from official country epidemiological reports. Mixed effects logistic regression was used to assess the association of variables with LST limitation decisions | ||
| 520 | |a RESULTS: Among 4671 severe COVID-19 patients admitted from February 25 to May 4, 2020, the prevalence of in-ICU LST limitations was 14.5%, with a nearly six-fold variability between centres. Overall 28-day cumulative incidence of LST limitations was 12.4%, which occurred at a median of 8 days (3-21). Median ICU load at the patient level was 126%. Age, clinical frailty scale score, and respiratory severity were associated with LST limitations, while ICU load was not. In-ICU death occurred in 74% and 95% of patients, respectively, after LST withholding and withdrawal, while median survival time was 3 days (1-11) after LST limitations | ||
| 520 | |a CONCLUSIONS: In this study, LST limitations frequently preceded death, with a major impact on time of death. In contrast to ICU load, older age, frailty, and the severity of respiratory failure during the first 24 h were the main factors associated with decisions of LST limitations | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Acute respiratory distress syndrome | |
| 650 | 4 | |a COVID-19 | |
| 650 | 4 | |a Critical care | |
| 650 | 4 | |a Ethical | |
| 650 | 4 | |a Life-sustaining therapy | |
| 650 | 4 | |a Outcome | |
| 700 | 1 | |a Le Terrier, Christophe |e verfasserin |4 aut | |
| 700 | 1 | |a Poncet, Antoine |e verfasserin |4 aut | |
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| 700 | 1 | |a Weiss, Emmanuel |e verfasserin |4 aut | |
| 700 | 1 | |a Bourcier, Simon |e verfasserin |4 aut | |
| 700 | 0 | |a COVID-ICU study investigators |e verfasserin |4 aut | |
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