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Treatment limitations in intensive care units.
Lars Christensen1, Hanne Jensen, Steffen Kristensen
1Larsd90@gmail.com.
Danish Medical Journal
|August 6, 2021
Summary
Intensive care unit (ICU) patients often have treatment limitations, with significant interdepartmental variations observed in Danish ICUs. These differences are mainly due to patient case mix, not imminent death.
Area of Science:
- Critical Care Medicine
- Medical Ethics
- Health Services Research
Background:
- Patients in intensive care units (ICUs) may have treatment limitations or withdrawal if further intervention is deemed futile.
- Understanding patterns of treatment limitations is crucial for end-of-life care discussions and resource allocation.
Purpose of the Study:
- To investigate interdepartmental variations in treatment limitation patterns among Danish ICUs.
- To analyze the characteristics and outcomes of ICU patients with treatment limitations.
Main Methods:
- A prospective observational study involving screening of all patients admitted to three Danish ICUs over six months.
- Inclusion criteria: patients with treatment limitations or death within the ICU.
- Classification of end-of-life outcomes into five categories and comparison of limitation patterns across departments.
Main Results:
- Out of 1,132 admitted patients, 264 (23.3%) had treatment limitations or died.
- Mortality among included patients was 71.5%, with significant interdepartmental variation (52-85%) in mortality rates.
- Eight distinct limitation types were identified, with variations attributed to case mix differences; 96% had chronic conditions, and 15-48% survived ICU discharge.
Conclusions:
- Treatment limitations are common in Danish ICUs, but significant interdepartmental differences exist, primarily driven by patient case mix.
- While many patients with limitations die, the imposition of limitations does not necessarily predict imminent death.
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