Treatment limitations at admission to intensive care units in Australia and New Zealand
| Autor: | George Ep Godfrey, David Pilcher, Rinaldo Bellomo, Michael Bailey, Carol L. Hodgson, Andrew Hilton |
|---|---|
| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Palliative care Databases Factual Shock Cardiogenic MEDLINE Comorbidity Critical Care and Intensive Care Medicine law.invention Patient Admission law Intensive care Epidemiology medicine Humans Hospital Mortality Intensive care medicine APACHE Aged Retrospective Studies Withholding Treatment business.industry Age Factors Australia Retrospective cohort study Length of Stay Middle Aged Subarachnoid Hemorrhage Respiration Disorders Euthanasia Passive Shock Septic Intensive care unit Heart Arrest Stroke Intensive Care Units Elective Surgical Procedures Intestinal Perforation Life support Multivariate Analysis Female Kidney Diseases Gastrointestinal Hemorrhage business Intracranial Hemorrhages New Zealand |
| Zdroj: | Critical Care Medicine. 40:2082-2089 |
| ISSN: | 0090-3493 |
| DOI: | 10.1097/ccm.0b013e31824ea045 |
| Popis: | Previous studies have addressed patients in whom treatment is withheld or withdrawn after a period of intensive care unit management. However, no studies have investigated the epidemiology of patients with treatment limitations in place at the time of intensive care unit admission.To report the epidemiology and outcome of patients with treatment limitations at intensive care unit admission and to identify characteristics associated with survival and discharge to home.Retrospective database study using data from the Australian and New Zealand Intensive Care Society Adult Patient Database.Australian and New Zealand intensive care units.One hundred eighty-seven thousand four hundred and one intensive care patients collected over a 3-yr period, 5,989 (3.2%) of whom had treatment limitations at admission to the intensive care unit.Retrospective database study with no interventions. Data collected included patient characteristics, length of stay, mortality, and discharge destination. Mean intensive care unit bed days were used as a surrogate for resource consumption.Between January 1, 2007, and December 31, 2009, 5,989 (3.2%) patients were reported to the Australia and New Zealand Intensive Care Society Adult Patient Database who had treatment limitation orders at admission to intensive care unit. Mortality was 53% (95% confidence interval 51.7%-54.3%) compared with 9% (95% confidence interval 8.9%-9.1%) in patients admitted for full active management (p ≤ .001). Overall, 30% of patients with treatment limitations were discharged directly to their homes. Intensive care unit bed day usage was similar between the two groups. Within the treatment limitation group, younger patients, those with less comorbid diseases, less acute physiological disturbance, and those admitted following elective surgery, were more likely to survive and be discharged home. Admission diagnosis was an important determinant of outcome with intracranial or subarachnoid hemorrhage predicting a extremely high mortality.Patients with treatment limitations on intensive care unit admission comprise approximately 2,000 patients per year in Australia and New Zealand. Despite such limitations, almost half of these patients survive their hospital admission and a third return directly to their home. |
| Databáze: | OpenAIRE |
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