TY - JOUR
T1 - End of life decisions in immunocompromised patients with acute respiratory failure
AU - for the Efraim investigators and the Nine-I study group
AU - Burghi, Gaston
AU - Metaxa, Victoria
AU - Pickkers, Peter
AU - Soares, Marcio
AU - Rello, Jordi
AU - Bauer, Philippe R.
AU - van de Louw, Andry
AU - Taccone, Fabio Silvio
AU - Loeches, Ignacio Martin
AU - Schellongowski, Peter
AU - Rusinova, Katerina
AU - Antonelli, Massimo
AU - Kouatchet, Achille
AU - Barratt-Due, Andreas
AU - Valkonen, Miia
AU - Pène, Frédéric
AU - Mokart, Djamel
AU - Jaber, Samir
AU - Azoulay, Elie
AU - De Jong, Audrey
N1 - Publisher Copyright:
© 2022 Elsevier Inc.
PY - 2022/12
Y1 - 2022/12
N2 - Purpose: To identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure. Material and methods: We performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs. Results: The main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54–71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01–1.03,P < 0.001), poor performance status (OR 2.79, 95% CI 1.98–3.93, P < 0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45–2.75, P < 0.001), liver failure (OR 1.59, 95% CI 1.14–2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31–2.46, P < 0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36–2.52, P < 0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11–2.38, P = 0.012). Conclusions: A DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.
AB - Purpose: To identify patient, disease and organizational factors associated with decisions to forgo life-sustaining therapies (DFLSTs) in critically ill immunocompromised patients admitted to the intensive care unit (ICU) for acute respiratory failure. Material and methods: We performed a secondary analysis of the international EFRAIM prospective study, which enrolled 1611 immunocompromised patients with acute respiratory failure admitted to 68 ICUs in 16 countries between October 2015 and June 2016. Multivariate logistic analysis was performed to identify independent predictors of DFLSTs. Results: The main causes of immunosuppression were hematological malignancies (50%) and solid tumor (38%). Patients had a median age of 63 yo (54–71). A pulmonologist was involved in the patient management in 38% of cases. DFLSTs had been implemented in 28% of the patients. The following variables were independently associated with DFLSTs: 1) patient-related: older age (OR 1.02 per one year increase, 95% confidence interval(CI) 1.01–1.03,P < 0.001), poor performance status (OR 2.79, 95% CI 1.98–3.93, P < 0.001); 2) disease-related: shock (OR 2.00, 95% CI 1.45–2.75, P < 0.001), liver failure (OR 1.59, 95% CI 1.14–2.21, P = 0.006), invasive mechanical ventilation (OR 1.79, 95% CI 1.31–2.46, P < 0.001); 3) organizational: having a pulmonologist involved in patient management (OR 1.85, 95% CI 1.36–2.52, P < 0.001), and the presence of a critical care outreach services (OR 1.63, 95% CI 1.11–2.38, P = 0.012). Conclusions: A DFLST is made in one in four immunocompromised patient admitted to the ICU for acute respiratory failure. Involving a pulmonologist in patient's management is associated with less non beneficial care.
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U2 - 10.1016/j.jcrc.2022.154152
DO - 10.1016/j.jcrc.2022.154152
M3 - Article
C2 - 36137351
AN - SCOPUS:85138220271
SN - 0883-9441
VL - 72
JO - Journal of Critical Care
JF - Journal of Critical Care
M1 - 154152
ER -