Nouvel Aurélie, Leprovost Pierre, Larrat Charlotte, Valette Xavier, Vinatier Isabelle, Delbove Agathe, Schnell David, Renault Anne, Cailliez Pauline, Jonas Maud, Guillot Pauline, Lemeur Anthony, Reignier Jean, Lancrey-Javal Théophile, Munoz Calahorro Reyes, Bobet Soline, Blonz Gauthier
Medical Intensive Care Unit, Nantes University Hospital, Nantes, France.
Medical-Surgical Intensive Care Unit, Le Mans Hospital, Le Mans, France.
Crit Care Explor. 2025 Aug 6;7(8):e1300. doi: 10.1097/CCE.0000000000001300. eCollection 2025 Aug 1.
The occurrence of death shortly after ICU admission raises concerns about the appropriateness of providing intensive care to frail patients-many of whom are subsequently subject to decisions to limit life-supporting treatment limitation (LST-L). The proportion of patients who die early and are affected by such limitations remains unknown.
The primary objective was to determine the proportion of patients with a decision of LST-L among patients who died within 48 hours after ICU admission. We also conducted analyses to identify variables associated with LST-L and collected staff perceptions.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective, observational, multicenter study with data collected immediately after the patient's death, according to predefined criteria. The study was conducted in 12 ICUs in France. Consecutive patients who died within 48 hours of ICU admission during the study period, in 2022-2023, were included. LST-L decisions were not guided by protocols but were at the discretion of the attending intensivists.
Of 1615 patients admitted to the participating ICUs during the study period, 100 died (6.2%) within 48 hours, including 62 with LST-L.
In the LST-L group, age was significantly older (72 yr [64-77.8 yr] vs. 63 yr [59.0-69.8 yr]; p = 0.002), Charlson Comorbidity Index significantly higher (5.5 [2.0-8.0] vs. 4.0 [2.0-5.0]; p < 0.001), and management less invasive compared with the full-care group. By multivariable analysis, male patients were less likely to have LST-L decisions (odds ratio, 0.35; 95% CI, 0.13-0.93; p = 0.03). Most physicians, but a smaller proportion of nurses, perceived LST-L decisions as consensual. For 28 of 100 patients, the intensivist retrospectively deemed the ICU admission not the most suitable option. Patient wishes were rarely considered when making LST-L decisions. Time-limited trials were rarely used. Two-thirds of LST-L decisions were made during on-call hours.
Deaths occurring shortly after ICU admission were usually preceded by LST-L decisions. Efforts are needed to better consider patients' wishes and to strengthen communication between ICU physicians and nursing staff, to ensure appropriate care-even when patients' wishes are unknown and alternatives to ICU admission are not straightforward. Such rare and sometimes unforeseeable cases may also reflect unspoken preferences of patients or their families.
在重症监护病房（ICU）入院后不久即死亡的情况引发了人们对为体弱患者提供重症监护的适宜性的担忧，其中许多患者随后会面临限制生命支持治疗（LST-L）的决定。早期死亡且受此类限制影响的患者比例尚不清楚。
主要目的是确定在ICU入院后48小时内死亡的患者中做出LST-L决定的患者比例。我们还进行了分析以确定与LST-L相关的变量并收集工作人员的看法。
设计、设置和参与者：一项回顾性、观察性、多中心研究，根据预定义标准在患者死亡后立即收集数据。该研究在法国的12个ICU中进行。纳入了在2022 - 2023年研究期间ICU入院后48小时内死亡的连续患者。LST-L决定不由方案指导，而是由主治重症监护医生自行决定。
在研究期间入住参与研究的ICU的1,615名患者中，100人（6.2%）在48小时内死亡，其中62人做出了LST-L决定。
在LST-L组中，年龄显著更大（72岁[64 - 77.8岁]对63岁[59.0 - 69.8岁]；p = 0.002），Charlson合并症指数显著更高（5.5[2.0 - 8.0]对4.0[2.0 - 5.0]；p < 0.001），与全护理组相比，管理侵入性较小。通过多变量分析，男性患者做出LST-L决定的可能性较小（比值比，0.35；95%置信区间，0.13 - 0.93；p = 0.03）。大多数医生，但护士中较小比例的人，认为LST-L决定是双方同意的。在100名患者中的28名中，重症监护医生事后认为ICU入院不是最合适的选择。在做出LST-L决定时很少考虑患者的意愿。很少使用限时试验。三分之二的LST-L决定是在值班时间做出的。
ICU入院后不久发生的死亡通常之前有LST-L决定。需要努力更好地考虑患者的意愿，并加强ICU医生和护理人员之间的沟通，以确保提供适当的护理，即使患者的意愿未知且ICU入院的替代方案不明确。此类罕见且有时不可预见的情况也可能反映患者或其家人未言明的偏好。
