End-of-life decision-making in respiratory intermediate care units: a European survey.

A survey was performed on behalf of the European Respiratory Society to assess end-of-life practices in patients admitted to European respiratory intermediate care units and high dependency units over a 6-month period. A 33-item questionnaire was sent by e-mail to physicians throughout Europe and the response rate was 28 (29.5%) out of 95. A total of 6,008 patients were admitted and an end-of-life decision was taken in 1,292 (21.5%). The mortality rate in these patients was 68% (884 out of 1,292). The patients received similar proportions of withholding of treatment (298 (23%) out of 1292), do-not-resuscitate or do-not-intubate orders (442 (34%) out of 1,292) and noninvasive mechanical ventilation as the ceiling of ventilatory care (402 (31%) out of 1,292). Withdrawal of therapy was employed in 149 (11%) out of 1,292 patients and euthanasia in one. Do-not-intubate/do-not-resuscitate orders were more frequently used in North compared with South Europe. All of the 473 competent patients directly participated in the decision, whereas, in 722 (56%) out of 1,292 cases, decision-making was reported to be shared with the nurses. In European respiratory intermediate care units and high dependency units, an end-of-life decision is taken for 21.5% of patients admitted. Withholding of treatment, do-not-intubate/do-not-resuscitate orders and noninvasive mechanical ventilation as the ventilatory care ceiling are the most common procedures. Competent patients are often involved, together with nurses.

[Specifics of identifying patients with sleep apnea syndrome (SAS) in Romania]. / Particularitati la depistarea pacientilor cu SAS în România.

After 7 years after the opening of the first somnography laboratory in Romania and screening of over 700 patients addressed for identification or therapy of SAS we managed to compare the group of pts with this disease to those in which the disease was not confirmed. Usually, disease was diagnosed in severe stages, there was a dominance of association with some well known risk factors: obesity, diabetes mellitus, male sex. Our study demonstrates a lack of education in patient level but also in physician level to provide CPAP as treatment due to lack of coverage by the Medical Insurance and high price of this kind of ventilatory assistance.