ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments

Abstract

ObjectiveTo analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure. DesignProspective, multicentrico. Scope62 ICU from Spain between February 2018 and March 2019. PatientsOver 18 years of age who were denied entry into ICU as a life support treatment limitation measure. InterventionsNone. Main interest variablesPatient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge. ResultsA total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62–3.99). ConclusionsDecisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.