Anest. intenziv. Med. 2006;17(5):261-265

Limitation of therapy in patients on ICU - a one-day national studyIntensive Care Medicine - Original Paper

R. Pařízková¹, V. Černý¹, K. Cvachovec², I. Novák³, V. Šrámek⁴, D. Nalos⁵

¹ Klinika anesteziologie, resuscitace a intenzivní medicíny UK v Praze, LF v Hradci Králové a Fakultní nemocnice Hradec Králové

² Anesteziologicko-resuscitační klinika 2. LF UK a Fakultní nemocnice v Motole, Praha

³ I. interní klinika UK v Praze, LF a Fakultní nemocnice, Plzeň

⁴ Anesteziologicko-resuscitační klinika LF Masarykovy univerzity a Fakultní nemocnice u sv. Anny v Brně

⁵ Anesteziologicko-resuscitační oddělení, Masarykova nemocnice, Ústí nad Labem

Objective:
The purpose of the study was to obtain information about patients experiencing any form of limitation of therapy (withdrawal - WD, or withholding - WH of therapy) and the way it is performed on the ICU.

Design:
Prospective, multi-centre, one-day prevalence study.


Setting:
Intensive Care units.

Materials and Methods:
An analysis of the posted questionnaires regarding ICU patients with limitations of therapy on the day of the study (16/3/2005) was performed. Information about the type of ICU, the patients with limitation of therapy and its form was obtained. Attention was paid to the documentation of EOLD in patient charts, informing the family and the maintained therapy.

Results:
78 ICUs in the Czech Republic took part in the survey. 32 (41%) of them were university-based, 39 (44%) were based in regional hospitals. 56 of the ICUs were run by anaesthesiologists and 22 by other specialties. On the day of the study there were 574 patients hospitalized on ICUs. In 48 (8.36%) of them withholding or withdrawal of therapy had been initiated. Limitation of therapy was documented in the patient charts in 79% of the cases, the family was informed in 64%. WH was employed in 31 (64.6%) patients,WD in 15 (31.2%) and terminal weaning in 1 patient (2%). WD was more frequent in university-based ICUs,WH in regional hospitals. The most commonly maintained supportive measures during EOLD included parenteral infusions, nutrition, analgesia with sedation and ventilatory support.

Conclusion:
The study documented the current techniques used in EOLD on ICUs in the Czech Republic. Withholding of therapy is generally preferred to withdrawal. The most frequently withdrawn therapeutic measures are haemodialysis and administration of catecholamines. Analgesia and sedation, nutrition, antibiotics and ventilatory support are usually maintained. Termination of ventilatory support is rarely used.

Keywords: limitation of therapy; intensive care

Published: October 1, 2006  Show citation