Laboratorio di Epidemiologia Clinica, Centro di Ricerche Cliniche per le Malattie Rare Aldo e Cele Daccò, Istituto di Ricerche Farmacologiche Mario Negri, 24020, Ranica, BG, Italy.
Intensive Care Med. 2010 Sep;36(9):1495-504. doi: 10.1007/s00134-010-1910-9. Epub 2010 May 13.
To appraise the end-of-life decision-making in several intensive care units (ICUs) and to evaluate the association between the average inclination to limit treatment and overall survival at ICU level.
Prospective, multicenter, observational study, lasting 12 months.
Eighty-four Italian, adult ICUs.
Consecutive patients (3,793) who died in ICU or were discharged in terminal condition, in 2005.
Data collection included patient description, treatment limitation and decision-makers, involvement of patients and relatives in the decision, and organ donation. A logistic regression model was used to identify predictors of treatment limitation and develop a measure of the inclination to limit treatment for each ICU. This was compared with the standardized mortality ratio, an index of the overall performance of the unit.
Treatment limitation preceded 62% of deaths. In 25% of cases, nurses were involved in the decision. Half the limitations were do-not-resuscitate orders, with the remaining half almost equally split between withholding and withdrawing treatment. Units less inclined to limit treatments (odds ratio <0.77) showed higher overall standardized mortality ratio (1.08; 95% confidence interval: 1.04-1.12).
The voluntary nature of participation, with self-selected ICUs from a self-selected independent network.
Treatment limitation is common in ICU and still principally a physician's responsibility. Units with below-average inclination to limit treatments have worse performance in terms of overall mortality, showing that limitation is not against the patient's interests. On the contrary, the inclination to limit treatments at the end of life can be taken as an indication of quality in the unit.
评价几个重症监护病房（ICU）的临终决策，并评估 ICU 水平治疗限制的平均倾向与总生存率之间的关系。
前瞻性、多中心、观察性研究，持续 12 个月。
84 家意大利成人 ICU。
2005 年在 ICU 死亡或出院时处于终末期的连续患者（3793 人）。
数据收集包括患者描述、治疗限制和决策者、患者和家属在决策中的参与情况以及器官捐献。使用逻辑回归模型确定治疗限制的预测因素，并为每个 ICU 制定治疗限制倾向的衡量标准。将这一衡量标准与标准化死亡率进行比较，标准化死亡率是单位整体表现的指标。
治疗限制发生在 62%的死亡病例之前。在 25%的情况下，护士参与了决策。一半的限制是不复苏命令，另一半几乎平均分为停止和停止治疗。限制治疗倾向较低的单位（比值比<0.77）的总体标准化死亡率较高（1.08；95%置信区间：1.04-1.12）。
参与的自愿性质，来自自我选择的独立网络的自我选择的 ICU。
治疗限制在 ICU 中很常见，仍然主要是医生的责任。限制治疗倾向低于平均水平的单位在总体死亡率方面表现较差，表明限制治疗不符合患者的利益。相反，在生命末期限制治疗的倾向可以作为单位质量的一个指标。
