End-of-life practices in 11 German intensive care units

Medizinische Klinik, Intensivmedizin Und Notfallmedizin · 14 authors, 13 centres

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TL;DR

A significant finding was that treatment preferences remained unknown for nearly half of the patients.

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Patients with limitations were older, more likely to have advance directives and decision-making capacity, and had longer ICU stays. Treatment preferences were unknown in 41.3% of patients. The findings suggest treatment limitations are common and often based on discussions, but the unknown wishes of nearly half the patients highlight a gap in guiding end-of-life decisions.

STUDY TYPE

cohort

SPECIALTY

critical care

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ORIGINAL PAPER

PMC10624715

End-of-life practices in 11 German intensive care units

Medizinische Klinik, Intensivmedizin Und Notfallmedizin

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ABSTRACT

Background End-of-life care is common in German intensive care units (ICUs) but little is known about daily practice. Objectives To study the practice of end-of-life care. Methods Prospectively planned, secondary analysis comprising the German subset of the worldwide Ethicus‑2 Study (2015–2016) including consecutive ICU patients with limitation of life-sustaining therapy or who died. Results Among 1092 (13.7%) of 7966 patients from 11 multidisciplinary ICUs, 967 (88.6%) had treatment limitations, 92 (8.4%) died with failed CPR, and 33 (3%) with brain death. Among patients with treatment limitations, 22.3% (216/967) patients were discharged alive from the ICU. More patients had treatments withdrawn than withheld (556 [57.5%] vs. 411 [42.5%], p < 0.001). Patients with treatment limitations were older (median 73 years [interquartile range (IQR) 61–80] vs. 68 years [IQR 54–77]) and more had mental decision-making capacity (12.9 vs. 0.8%), advance directives (28.6 vs. 11.2%), and information about treatment wishes (82.7 vs 33.3%, all p < 0.001). Physicians reported discussing treatment limitations with patients with mental decision-making capacity and families (91.3 and 82.6%, respectively). Patient wishes were unknown in 41.3% of patients. The major reason for decision-making was unresponsiveness to maximal therapy (34.6%). Conclusions Treatment limitations are common, based on information about patients’ wishes and discussion between stakeholders, patients and families. However, our findings suggest that treatment preferences of nearly half the patients remain unknown which affects guidance for treatment decisions. Supplementary Information The online version of this article (10.1007/s00063-022-00961-1) contains supplementary material, which is available to authorized users.

CITATION EXPORT

C. Denke, U. Jaschinski, R. Riessen et al.. End-of-life practices in 11 German intensive care units. Medizinische Klinik, Intensivmedizin Und Notfallmedizin. (2022). https://doi.org/10.1007/s00063-022-00961-1

AUTHORS

14 · 13 CENTRES

C. Denke, U. Jaschinski, R. Riessen, S. Bercker, C. Spies, M. Ragaller, M. Weiss, K. Dey, A. Michalsen, J. Briegel, A. Pohrt, C. L. Sprung, A. Avidan, C. S. Hartog

1https://ror.org/001w7jn25grid.6363.00000 0001 2218 4662Department of Anaesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin, Campus Virchow, Berlin, Germany
2https://ror.org/03b0k9c14grid.419801.50000 0000 9312 0220Department of Anesthesiology and Critical Care, Medicine, University Hospital Augsburg, Augsburg, Germany
3https://ror.org/00pjgxh97grid.411544.10000 0001 0196 8249Department of Internal Medicine, Medical Intensive Care Unit, Universitätsklinikum Tübingen, Tübingen, Germany
4https://ror.org/03s7gtk40grid.9647.c0000 0004 7669 9786Department of Anaesthesiology and Intensive, Care, University of Leipzig Medical Centre, Leipzig, Germany
5https://ror.org/04za5zm41grid.412282.f0000 0001 1091 2917Technical University Dresden, Department, of Anesthesiology and Intensive Care Medicine, Universitätsklinikum Carl Gustav Carus, Dresden, Germany
6https://ror.org/05emabm63grid.410712.1Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Ulm, Ulm, Germany
7Department of Anesthesiology and Intensive Care Medicine, Hospital of the Bundeswehr Berlin, Berlin, Germany
8Department of Anesthesiology, Critical Care, Emergency, Medicine, and Pain Therapy, Konstanz Hospital, Konstanz, Germany
9grid.411095.80000 0004 0477 2585Klinik für Anästhesiologie, LMU Klinikum München, Munich, Germany
10https://ror.org/001w7jn25grid.6363.00000 0001 2218 4662Institute of Biometry and Clinical Epidemiology, Charité Universitätsmedizin Berlin, Campus Charité Mitte, Berlin, Germany
11https://ror.org/03qxff017grid.9619.70000 0004 1937 0538Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
12grid.491865.70000 0001 0338 671XKlinik Bavaria Kreischa, Kreischa, Germany
13https://ror.org/001w7jn25grid.6363.00000 0001 2218 4662Department of Anesthesiology and Operative Intensive Care Medicine, Charité Universitätsmedizin Berlin; Campus Charité, Berlin, Germany