Triggers for Palliative Care consultation and its modalities in non-malignant mechanically ventilated patients in the Intensive Care Unit: A prospective observational study

Abstract

Aim and objectives

To determine the triggers for palliative care consultation (PCC) in non-malignant mechanically ventilated (MV) patients admitted to intensive care unit (ICU) and factors affecting modalities of palliative care (PC) delivery.

Material and methods

Single-centre prospective observational study was conducted on 104 adult non-malignant patients on MV and received PC during the ICU stay. Withhold of life-sustaining treatment (WHLS) and withdrawal of life-sustaining treatment (WDLS) were the two modalities of PC delivery.

Results

Of 104 non- malignant ICU patients on MV, WDLS was opted in 56 (53 %) and WHLS in 48 (46 %) by the patients’ legally authorized representatives. Patients with neurological dysfunction (either with or without septic shock) formed most cases receiving PC 64 (61.5 %). The median (IQR) of the number of hospitalizations in the preceeding two years was 2.5 (1-4 ) in the WDLA compared to WHLS 1 (1-2) [p < 0.001]. APACHE II score ≥25 even after seven days of invasive mechanical ventilation and aggressive medical therapy in ICU, Charlson comorbidity index (CCI) score ≥5 and ≥2 hospitalizations in the preceding two years are triggers of PC consultation. In multivariate analysis, higher APACHE score, higher the number of hospitalisations in the last 2 years and lower CCI score appear to predict WDLS against WHLS.

Conclusion

In our patient population of non-malignant patients admitted to ICU and receiving IMV (a) the neurological dysfunction comprised the largest group of non-malignant critically ill patients on IMV for PCC (b) Higher APACHE score and number of hospitalisations probably predicts the choice of WDLS (c) Further, large multicentred study with larger sample is required to generalise the study findings.