Ángel Estella , Carolina Lagares , María José Furones , Pilar Martínez López , Noelia Isabel Lázaro Martín , Belén Estebánez , Jose Manuel Gómez García , Olga Rubio , Bárbara Vidal Tejedor , Laura Galarza , Manuel Palomo Navarro , Vicent López Camps , Mari Cruz Martín , Juan Carlos Montejo , Alexander Avidan , Charles Sprung , Grupo de Trabajo de Bioética de la Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC)
{"title":"西班牙重症监护病房对维持生命治疗的限制：对 ETHICUS II 研究的分析","authors":"Ángel Estella , Carolina Lagares , María José Furones , Pilar Martínez López , Noelia Isabel Lázaro Martín , Belén Estebánez , Jose Manuel Gómez García , Olga Rubio , Bárbara Vidal Tejedor , Laura Galarza , Manuel Palomo Navarro , Vicent López Camps , Mari Cruz Martín , Juan Carlos Montejo , Alexander Avidan , Charles Sprung , Grupo de Trabajo de Bioética de la Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC)","doi":"10.1016/j.medin.2024.01.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Objective</h3><p>The aim of this study is to describe the results of Spanish ICUs in ETHICUS II study.</p></div><div><h3>Design</h3><p>Planned substudy of patients from ETHICUS II study.</p></div><div><h3>Setting</h3><p>12 Spanish ICU.</p></div><div><h3>Patients or participants</h3><p>Patients admitted to Spanish ICU who died or in whom a limitation of life-sustaining treatment (LLST) was decided during a recruitment period of 6 months.</p></div><div><h3>Interventions</h3><p>Follow-up of patients was performed until discharge from the ICU and 2 months after the decision of LLST or death.</p></div><div><h3>Main variables of interest</h3><p>Demographic characteristics, clinical profile, type of decision of LLST, time and form in which it was adopted. Patients were classified into 4 categories according to the ETHICUS II study protocol: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, failed cardiopulmonary resuscitation and patients with brain death.</p></div><div><h3>Results</h3><p>A total of 795 patients were analyzed; 129 patients died after CPR, 129 developed brain death. LLST was decided in 537 patients, 485 died in the ICU, 90.3%. The mean age was 66.19 years<!--> <!-->±<!--> <!-->14.36, 63.8% of male patients. In 221 (41%) it was decided to withdraw life-sustaining treatments and in 316(59%) withholding life-sustaining treatments. Nineteen patients (2.38%) had advance living directives.</p></div><div><h3>Conclusions</h3><p>The predominant clinical profile when LTSV was established was male patients over 65 years with mostly cardiovascular comorbidity.</p><p>We observed that survival was higher in LLST decisions involving withholding of treatments compared to those in which withdrawal was decided.</p><p>Spain has played a leading role in both patient and ICU recruitment participating in this worldwide multicenter study.</p></div>","PeriodicalId":49268,"journal":{"name":"Medicina Intensiva","volume":"48 5","pages":"Pages 247-253"},"PeriodicalIF":2.7000,"publicationDate":"2024-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Limitación de tratamientos de soporte vital en Unidades de Cuidados Intensivos españolas: análisis del estudio ETHICUS II\",\"authors\":\"Ángel Estella , Carolina Lagares , María José Furones , Pilar Martínez López , Noelia Isabel Lázaro Martín , Belén Estebánez , Jose Manuel Gómez García , Olga Rubio , Bárbara Vidal Tejedor , Laura Galarza , Manuel Palomo Navarro , Vicent López Camps , Mari Cruz Martín , Juan Carlos Montejo , Alexander Avidan , Charles Sprung , Grupo de Trabajo de Bioética de la Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMICYUC)\",\"doi\":\"10.1016/j.medin.2024.01.014\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objective</h3><p>The aim of this study is to describe the results of Spanish ICUs in ETHICUS II study.</p></div><div><h3>Design</h3><p>Planned substudy of patients from ETHICUS II study.</p></div><div><h3>Setting</h3><p>12 Spanish ICU.</p></div><div><h3>Patients or participants</h3><p>Patients admitted to Spanish ICU who died or in whom a limitation of life-sustaining treatment (LLST) was decided during a recruitment period of 6 months.</p></div><div><h3>Interventions</h3><p>Follow-up of patients was performed until discharge from the ICU and 2 months after the decision of LLST or death.</p></div><div><h3>Main variables of interest</h3><p>Demographic characteristics, clinical profile, type of decision of LLST, time and form in which it was adopted. Patients were classified into 4 categories according to the ETHICUS II study protocol: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, failed cardiopulmonary resuscitation and patients with brain death.</p></div><div><h3>Results</h3><p>A total of 795 patients were analyzed; 129 patients died after CPR, 129 developed brain death. LLST was decided in 537 patients, 485 died in the ICU, 90.3%. The mean age was 66.19 years<!--> <!-->±<!--> <!-->14.36, 63.8% of male patients. In 221 (41%) it was decided to withdraw life-sustaining treatments and in 316(59%) withholding life-sustaining treatments. Nineteen patients (2.38%) had advance living directives.</p></div><div><h3>Conclusions</h3><p>The predominant clinical profile when LTSV was established was male patients over 65 years with mostly cardiovascular comorbidity.</p><p>We observed that survival was higher in LLST decisions involving withholding of treatments compared to those in which withdrawal was decided.</p><p>Spain has played a leading role in both patient and ICU recruitment participating in this worldwide multicenter study.</p></div>\",\"PeriodicalId\":49268,\"journal\":{\"name\":\"Medicina Intensiva\",\"volume\":\"48 5\",\"pages\":\"Pages 247-253\"},\"PeriodicalIF\":2.7000,\"publicationDate\":\"2024-03-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Medicina Intensiva\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S0210569124000615\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Medicina Intensiva","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0210569124000615","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Limitación de tratamientos de soporte vital en Unidades de Cuidados Intensivos españolas: análisis del estudio ETHICUS II
Objective
The aim of this study is to describe the results of Spanish ICUs in ETHICUS II study.
Design
Planned substudy of patients from ETHICUS II study.
Setting
12 Spanish ICU.
Patients or participants
Patients admitted to Spanish ICU who died or in whom a limitation of life-sustaining treatment (LLST) was decided during a recruitment period of 6 months.
Interventions
Follow-up of patients was performed until discharge from the ICU and 2 months after the decision of LLST or death.
Main variables of interest
Demographic characteristics, clinical profile, type of decision of LLST, time and form in which it was adopted. Patients were classified into 4 categories according to the ETHICUS II study protocol: withholding or withdrawing life-sustaining therapy, active shortening of the dying process, failed cardiopulmonary resuscitation and patients with brain death.
Results
A total of 795 patients were analyzed; 129 patients died after CPR, 129 developed brain death. LLST was decided in 537 patients, 485 died in the ICU, 90.3%. The mean age was 66.19 years ± 14.36, 63.8% of male patients. In 221 (41%) it was decided to withdraw life-sustaining treatments and in 316(59%) withholding life-sustaining treatments. Nineteen patients (2.38%) had advance living directives.
Conclusions
The predominant clinical profile when LTSV was established was male patients over 65 years with mostly cardiovascular comorbidity.
We observed that survival was higher in LLST decisions involving withholding of treatments compared to those in which withdrawal was decided.
Spain has played a leading role in both patient and ICU recruitment participating in this worldwide multicenter study.
期刊介绍：
Medicina Intensiva is the journal of the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC) and of Pan American and Iberian Federation of Societies of Intensive and Critical Care Medicine. Medicina Intensiva has become the reference publication in Spanish in its field. The journal mainly publishes Original Articles, Reviews, Clinical Notes, Consensus Documents, Images, and other information relevant to the specialty. All works go through a rigorous selection process. The journal accepts submissions of articles in English and in Spanish languages. The journal follows the publication requirements of the International Committee of Medical Journal Editors (ICMJE) and the Committee on Publication Ethics (COPE).
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