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. 2018 Jul;44(7):1027-1038.
doi: 10.1007/s00134-018-5196-7. Epub 2018 May 17.

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

Bertrand Guidet  1   2 , Hans Flaatten  3   4 , Ariane Boumendil  5 , Alessandro Morandi  6   7 , Finn H Andersen  8   9 , Antonio Artigas  10 , Guido Bertolini  11 , Maurizio Cecconi  12 , Steffen Christensen  13 , Loredana Faraldi  14 , Jesper Fjølner  13 , Christian Jung  15 , Brian Marsh  16 , Rui Moreno  17 , Sandra Oeyen  18 , Christina Agwald Öhman  19 , Bernardo Bollen Pinto  20 , Ivo W Soliman  21 , Wojciech Szczeklik  22 , Andreas Valentin  23 , Ximena Watson  12 , Tilemachos Zafeiridis  24 , Dylan W De Lange  21 ; VIP1 study group
Collaborators, Affiliations
Free article

Withholding or withdrawing of life-sustaining therapy in older adults (≥ 80 years) admitted to the intensive care unit

Bertrand Guidet et al. Intensive Care Med. 2018 Jul.
Free article

Erratum in

Abstract

Purpose: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU.

Methods: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up.

Results: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision). Patients with LST limitation were older, more frail, more severely ill and less frequently electively admitted. Patients with withdrawal of LST were more frequently male and had a longer ICU length of stay. The ICU and 30-day mortality were, respectively, 29.1 and 53.1% in the withholding group and 82.2% and 93.1% in the withdrawal group. LST was less frequently limited in eastern and southern European countries than in northern Europe. The patient-independent factors associated with LST limitation were: acute ICU admission (OR 5.77, 95% CI 4.32-7.7), Clinical Frailty Scale (CFS) score (OR 2.08, 95% CI 1.78-2.42), increased age (each 5 years of increase in age had a OR of 1.22 (95% CI 1.12-1.34) and SOFA score [OR of 1.07 (95% CI 1.05-1.09 per point)]. The frequency of LST limitation was higher in countries with high GDP and was lower in religious countries.

Conclusions: The most important patient variables associated with the instigation of LST limitation were acute admission, frailty, age, admission SOFA score and country.

Trial registration: ClinicalTrials.gov (ID: NTC03134807).

Keywords: Elderly; Ethics; Intensive care; Life sustaining treatment; Withdrawal; Withholding.

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