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Inicio Revista Española de Anestesiología y Reanimación (English Edition) Factors associated with limitation of life support: Post-ICU mortality case stud...
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Original article
Available online 22 February 2024
Factors associated with limitation of life support: Post-ICU mortality case study of a tertiary hospital
Factores asociados a la limitación del soporte vital: estudio de casos de mortalidad post-UCI de un hospital terciario
U.A. López Gonzáleza,
Corresponding author
ulogon@alumni.uv.es

Corresponding author.
, D. Bautista Renteroa, M. Crespo Gómezb, P. Cárcamo Ibarrac, A.M. Míguez Santiyána
a Servicio de Medicina Preventiva, Hospital Universitario Doctor Peset, Valencia, Spain
b Servicio de Medicina Intensiva, Hospital Universitario Doctor Peset, Valencia, Spain
c Servicio de Medicina Nuclear, Hospital Clínico Universitario de Valencia, Valencia, Spain
Received 01 March 2023. Accepted 22 May 2023
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Tables (3)
Table 1. Characteristics of post-ICU mortality cases according to limitation of life-sustaining treatment (LLSV) in the ICU.
Table 2. Multivariate logistic regression model of limitation of life-sustaining treatment (LLSV) in the ICU.
Table 3. Variables included in the Cox Regression model of days of post-ICU stay.
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Abstract
Background

Life-sustaining treatment limitation (LSV) is the medical act of withdrawing or not initiating measures that are considered futile in a patient's specific situation. LSV in critically ill patients remains a difficult topic to study, due to the multitude of factors that condition it.

Objective

To determine factors related to LSV in ICU in cases of post-ICU in-hospital mortality, as well as factors associated with survival after discharge from ICU.

Design

Retrospective longitudinal study.

Ambit

Intensive care unit of a tertiary hospital.

Patients

People who died in the hospitalization ward after ICU treatment between January 2014 and December 2019.

Interventions

None. This is an observational study.

Variables of interest

Age, sex, probability of death, type of admission, LSV in ICU, oncological disease, dependence, invasive mechanical ventilation, emergency hemodialysis, transfusion of blood products, nosocomial infection (NI), pre-ICU, intra-ICU and post-ICU stays.

Results

Of 114 patients who died outside the ICU, 49 had LSV registered in the ICU (42.98%). Age and stay prior to ICU admission were positively associated with LSV (OR 1,03 and 1,08, respectively). Patients without LSV had a higher post-ICU stay, while it was lower for male patients.

Conclusions

Our results support that LSV established within the ICU can avoid complications commonly associated with unnecessary prolongation of stay, such as NI.

Keywords:
Life-sustaining treatment limitation
Medical futility
Withholding
Intensive care
Nosocomial infections
Resumen
Antecedentes

La limitación del tratamiento de soporte vital (LSV) es el acto médico de retirar o no iniciar medidas que se consideren fútiles en la situación concreta de un paciente. La LSV en pacientes críticos sigue siendo un tema difícil de estudiar, debido a la multitud de factores que la condicionan.

Objetivo

Determinar los factores relacionados con la LSV en UCI en casos de mortalidad hospitalaria post-UCI, así como los factores asociados a los días de supervivencia tras el alta de UCI.

Diseño

Estudio longitudinal retrospectivo.

Ámbito

Unidad de cuidados intensivos de un hospital terciario.

Pacientes

Personas fallecidas en sala de hospitalización tras tratamiento en UCI entre enero de 2014 y diciembre de 2019.

Intervenciones

No existen. Se trata de un estudio observacional.

Variables de interés

Edad, sexo, probabilidad de muerte, tipo de ingreso, LSV en UCI, enfermedad oncológica, dependencia, ventilación mecánica invasiva y hemodiálisis de urgencia, transfusión de hemoderivados, infección nosocomial (IN), estancias pre-UCI, intra-UCI y post-UCI.

Resultados

De 114 pacientes fallecidos fuera de la UCI, 49 tenían registrada LSV en UCI (42,98%). La edad y la estancia previa al ingreso en UCI se asociaron positivamente a LSV (OR 1,03 y 1,08, respectivamente) y la IN, negativamente (OR 0,19). Los pacientes sin LSV presentaron una estancia post-UCI más alta, mientras que en los pacientes varones fue menor.

Conclusiones

Nuestros resultados apoyan que la LSV instaurada dentro de UCI puede relacionarse con un menor número de complicaciones comúnmente asociadas a la prolongación innecesaria de la estancia, como la IN.

Palabras clave:
Limitación del soporte vital
Inutilidad médica
Retiro de la atención
Cuidados intensivos
Infección hospitalaria

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