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Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study / Factores relacionados con la limitación del tratamiento de soporte vital en las primeras 48h de ingreso en unidades de cuidados intensivos: estudio multicéntrico
Blazquez, V; Rodríguez, A; Sandiumenge, A; Oliver, E; Cancio, B; Ibañez, M; Miró, G; Navas, E; Badía, M; Bosque, MD; Jurado, MT; López, M; Llauradó, M; Masnou, N; Pont, T; Bodí, M.
Afiliação
  • Blazquez, V; University Hospital Joan XXIII. Intensive Care Unit. Tarragona. Spain
  • Rodríguez, A; University Rovira i Virgili. Institut d'Investigació Sanitària Pere Virgili. University Hospital Joan XXIII. Intensive Care Unit. Tarragona. Spain
  • Sandiumenge, A; University Hospital Vall d'Hebron. Transplant Coordination. Barcelona. Spain
  • Oliver, E; University Hospital Bellvitge. Transplant Coordination. Barcelona. Spain
  • Cancio, B; University Hospital Moises Broggi. Intensive Care Unit. Barcelona. Spain
  • Ibañez, M; University Hospital Verge de la Cinta de Tortosa. Intensive Care Unit. Tortosa. Spain
  • Miró, G; Consorci Sanitari del Maresme. Intensive Care Unit. Mataró. Spain
  • Navas, E; University Hospital Mutua de Terrassa. Intensive Care Unit. Terrassa. Spain
  • Badía, M; University Hospital Arnau de Vilanova. Intensive Care Unit. Lleida. Spain
  • Bosque, MD; University Hospital General de Catalunya. Intensive Care Unit. Barcelona. Spain
  • Jurado, MT; Hospital de Terrassa. Intensive Care Unit. Terrassa. Spain
  • López, M; University Hospital de Vic. Intensive Care Unit. Vic. Spain
  • Llauradó, M; International University of Catalunya. Barcelona. Spain
  • Masnou, N; University Hospital Doctor Trueta. Transplant Coordination. Girona. Spain
  • Pont, T; University Hospital Vall d'Hebron. Transplant Coordination. Barcelona. Spain
  • Bodí, M; University Rovira i Virgili. Institut d'Investigació Sanitària Pere Virgili. University Hospital Joan XXIII. Intensive Care Unit. Tarragona. Spain
Med. intensiva (Madr., Ed. impr.) ; 43(6): 352-361, ago.-sept. 2019. graf, tab
Artigo em Inglês | IBECS | ID: ibc-183254
Biblioteca responsável: ES1.1
Localização: BNCS
ABSTRACT

Objective:

To determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission. Study

design:

Prospective multicenter study.

Setting:

Eleven ICUs. Patients All patients who died and/or had limitations on life support after ICU admission during a four-month period. Variables Patient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early (<48h of admission) or late (≥48h). We performed univariate, multivariate analyses and CHAID (chi-square automatic interaction detection) analysis of variables associated with limitation of life support within 48h of ICU admission.

Results:

3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%-84.2%). The median (p25-p75) time from admission to initial limitation was 2 (0-7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR=2.5; 95% CI 1.5-4.4) and lung disease was the variable most strongly associated with early limitations (OR=12.29; 95% CI 1.63-255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR=2.4; 95% CI 1.1-5.5).

Conclusion:

Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48h of admission
RESUMEN

Objetivo:

Determinar los factores relacionados con la limitación del tratamiento de soporte vital (LTSV) en las primeras 48h de ingreso en Unidades de Cuidados Intensivos (UCI).

Diseño:

Multicéntrico prospectivo. Ámbito Once UCI. Pacientes Pacientes fallecidos y/o en los que se aplicó LTSV durante 4 meses. Variables de interés Características de pacientes, hospital y LTSV. Se definió LTSV precoz la que ocurría en las primeras 48h de ingreso y tardía >48h. Realizamos análisis univariado, multivariado y árbol de decisión chi-square automatic interaction detection (CHAID) con las variables asociadas con LTSV en las primeras 48h.

Resultados:

Incluidos 3.335 pacientes, en 326 (9,8%) se aplicó LTSV y 344 fallecieron; de estos 247 (71,8%) se limitaron (variabilidad interhospitalaria 58,6-84,2%). La mediana de tiempo (p25-p75) entre el ingreso y la LTSV inicial fue de 2 (0-7) días. El análisis CHAID evidenció que la escala de Rankin modificada fue la variable más estrechamente relacionada con la limitación precoz. Entre los pacientes con Rankin>2 la LTSV precoz se realizó en el 71,7% (OR=2,5; IC 95% 1,5-4,4) y la enfermedad pulmonar fue la variable más relacionada con la LTSV precoz (OR=12,29; IC 95% 1,63-255,91). Entre los pacientes con Rankin≤2, la LTSV precoz ocurrió en el 48,8% siendo los pacientes con cirugía urgente aquellos con mayor LTSV precoz (66,7%; OR=2,4; IC 95% 1,1-5,5).

Conclusión:

La LTSV es común pero la práctica es variable. La calidad de vida es la variable que mayor impacto tiene sobre la LTSV en las primeras 48h del ingreso en la UCI
Assuntos

Texto completo: Disponível Coleções: Bases de dados nacionais / Espanha Base de dados: IBECS Assunto principal: Suporte Vital Cardíaco Avançado / Unidades de Terapia Intensiva Limite: Idoso / Humanos Idioma: Inglês Revista: Med. intensiva (Madr., Ed. impr.) Ano de publicação: 2019 Tipo de documento: Artigo Instituição/País de afiliação: Consorci Sanitari del Maresme/Spain / Hospital de Terrassa/Spain / International University of Catalunya/Spain / University Hospital Arnau de Vilanova/Spain / University Hospital Bellvitge/Spain / University Hospital Doctor Trueta/Spain / University Hospital General de Catalunya/Spain / University Hospital Joan XXIII/Spain / University Hospital Moises Broggi/Spain / University Hospital Mutua de Terrassa/Spain

Texto completo: Disponível Coleções: Bases de dados nacionais / Espanha Base de dados: IBECS Assunto principal: Suporte Vital Cardíaco Avançado / Unidades de Terapia Intensiva Limite: Idoso / Humanos Idioma: Inglês Revista: Med. intensiva (Madr., Ed. impr.) Ano de publicação: 2019 Tipo de documento: Artigo Instituição/País de afiliação: Consorci Sanitari del Maresme/Spain / Hospital de Terrassa/Spain / International University of Catalunya/Spain / University Hospital Arnau de Vilanova/Spain / University Hospital Bellvitge/Spain / University Hospital Doctor Trueta/Spain / University Hospital General de Catalunya/Spain / University Hospital Joan XXIII/Spain / University Hospital Moises Broggi/Spain / University Hospital Mutua de Terrassa/Spain
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