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Updated: Mar 15, 2026

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Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care

Sandra Regina Gonzaga Mazutti1, Andréia de Fátima Nascimento2, Renata Rego Lins Fumis3

  • 1Unidade de Terapia Intensiva, Hospital Paulistano, São Paulo, SP, Brazil.

Revista Brasileira De Terapia Intensiva
|September 15, 2016
PubMed

Insights

Integrated palliative care in intensive care units facilitates orthothanasia, the practice of not prolonging life artificially. This study found limitations to advanced life support were common, often occurring early in hospitalization.

Area of Science:

  • Critical Care Medicine
  • Palliative Care
  • Medical Ethics

Background:

  • Integrated palliative care in intensive care units (ICUs) is crucial for managing critically ill patients.
  • Understanding limitations to Advanced Life Support (ALS) is essential for ethical end-of-life care.

Purpose of the Study:

  • To determine the incidence of limitations to Advanced Life Support (ALS) in critically ill patients within an ICU setting with integrated palliative care.
  • To analyze the types and timing of ALS limitations implemented.

Main Methods:

  • Retrospective cohort study of 342 adult patients in an ICU palliative care program from May 2011 to January 2014.
  • Analyzed limitations including do-not-resuscitate orders, mechanical ventilation, dialysis, and vasoactive drugs.
  • Statistical analysis included central tendency measures, chi-squared, and Wilcoxon tests.

Main Results:

  • Of 3,487 ICU admissions, 342 patients were in the palliative care program.
  • Limitations to ALS frequently occurred within the first day of hospitalization (42.7%).
  • Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most common ALS limitations.

Conclusions:

  • Integrated palliative care significantly contributes to the practice of orthothanasia in ICUs.
  • Orthothanasia involves the judicious non-extension of life through artificial means for critically ill patients.
  • The study highlights the importance of early palliative care integration for end-of-life decision-making.
Abstract

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