Evolution of end-of-life practices in a Spanish intensive care unit between 2002 and 2009.

BACKGROUND

Spanish cultural perception of end-of-life decision making has started to change within a new legal framework.

OBJECTIVES

The objective of this study was to describe how life-sustaining treatments (LST) were withheld or withdrawn in an intensive care unit (ICU), to determine the degree of agreement between physicians and patients' families on end-of-life decisions, and to compare our results to those of studies undergone before these legal changes.

DESIGN

This was an observational retrospective study.

SETTING/SUBJECTS: The setting and subjects were patients admitted to a medical and surgical ICU in a metropolitan tertiary care center from January 2002 to December 2009 whose LST had been withheld or withdrawn.

MEASUREMENTS

Study measurements included age and sex; comorbidities; functional status on admission; main diagnosis; SAPS II and APACHE II scores on admission; degree of agreement on end-of-life practices; and therapeutic interventions withheld or withdrawn and outcome.

RESULTS

A total of 371 of 6526 patients (5.7%) had LST withheld or withdrawn; 339 of these patients died in the ICU. Patients whose LST was withheld or withdrawn were older, had a high number of comorbidities, and were admitted with higher SAPS II and APACHE II scores than the general ICU population. Active treatments and basic support were discontinued in 212 patients (57%) and 100 patients (26.9%), respectively. An agreement between the staff and the patient's family was reached in 318 cases (85.7%). Families were not involved in 30 cases (8.1%).

CONCLUSIONS

Compared to prior studies, shared end-of-life decision making in the ICU has increased in recent years. Decisions to forgo treatments mainly involve advanced life support.