Factors related to limitation of life support within 48h of intensive care unit admission: A multicenter study

Abstract

Objective: To determine factors related to limitations on life support within 48h of intensive care unit (ICU) admission.

Study design: Prospective multicenter study.

Setting: Eleven ICUs.

Patients: All patients who died and/or had limitations on life support after ICU admission during a four-month period.

Variables: Patient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early (<48h of admission) or late (≥48h). We performed univariate, multivariate analyses and CHAID (chi-square automatic interaction detection) analysis of variables associated with limitation of life support within 48h of ICU admission.

Results: 3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%-84.2%). The median (p25-p75) time from admission to initial limitation was 2 (0-7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR=2.5; 95% CI: 1.5-4.4) and lung disease was the variable most strongly associated with early limitations (OR=12.29; 95% CI: 1.63-255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR=2.4; 95% CI: 1.1-5.5).

Conclusion: Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48h of admission.

Keywords: Decisiones al final de la vida; End-of-life decisions; Intensive care unit; Life-support treatment limitation; Limitación del tratamiento de soporte vital; Unidad de Cuidados Intensivos; Withdrawing; Withholding.