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1: Intensive Care Med. 2008 Oct 10. [Epub ahead of print]
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End-of-life practices in 282 intensive care units: data from the SAPS 3 database.

Azoulay E, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P, Schlemmer B, Moreno R, Metnitz P; on behalf of the SAPS 3 investigators.

Service de Réanimation Médicale, Hôpital Saint-Louis et Université Paris 7, Assistance Publique, Hôpitaux de Paris, Paris, France, elie.azoulay@sls.ap-hop-paris.fr.

OBJECTIVE: To report incidence and characteristics of decisions to forgo life-sustaining therapies (DFLSTs) in the 282 ICUs who contributed to the SAPS3 database. METHODS: We reviewed data on DFLSTs in 14,488 patients. Independent predictors of DFLSTs have been identified by stepwise logistic regression. RESULTS: DFLSTs occurred in 1,239 (8.6%) patients [677 (54.6%) withholding and 562 (45.4%) withdrawal decisions]. Hospital mortality was 21% (3,050/14,488); 36.2% (1,105) deaths occurred after DFLSTs. Across the participating ICUs, hospital mortality in patients with DFLSTs ranged from 80.3 to 95.4% and time from admission to decisions ranged from 2 to 4 days. Independent predictors of decisions to forgo LSTs included 13 variables associated with increased incidence of DFLSTs and 7 variables associated with decrease incidence of DFLST. Among hospital and ICU-related variables, a higher number of nurses per bed was associated with increased incidence of DFLST, while availability of an emergency department in the same hospital, presence of a full time ICU-specialist and doctors presence during nights and week-ends were associated with a decreased incidence of DFLST. CONCLUSION: This large study identifies structural variables that are associated with substantial variations in the incidence and the characteristics of decisions to forgo life-sustaining therapies.

PMID: 18850088 [PubMed - as supplied by publisher]