Clinical factors associated with therapeutic effort limitation in critically ill patients: A descriptive study

To analyze the decisions regarding the limitation of therapeutic effort (LTE) adopted in an adult intensive care unit (ICU) MATERIAL AND METHODS: Observational, descriptive, and cross-sectional study conducted in the adult ICU of a university hospital, equipped with 21 beds and an average of 1,000 annual medical and surgical admissions. All TEL decisions documented during the study period were included; patients diagnosed with brain death were excluded. Clinical, functional, and prognostic variables were collected using validated scales such as APACHE II, Charlson, Karnofsky, Barthel, PAEEC, MPM II, and ODIN.

A total of 1,012 admissions were analyzed, with an intra-ICU mortality rate of 12.9%. Fifty-four cases of TEL were identified (5.3% of all admissions and 42.8% of deaths). The main reason was clinical irreversibility (71%), followed by therapeutic futility (29%). Seventy-two percent of patients were male, with a mean age of 70.5 ± 10.9 years. The median Charlson comorbidity index was 6. Altered baseline quality of life was observed in 68.5% of patients, with moderate to severe impairment in 24.1%. The mean APACHE II score at admission was 22.6 ± 8.6, with an estimated mortality probability of 44.7%.

TEL is a common practice in elderly patients with significant comorbidities and prior functional decline, highlighting the need to establish clear clinical criteria and standardized protocols for its implementation in adult ICUs.