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Vol. 46. Issue 4.
Pages 192-200 (April 2022)
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Vol. 46. Issue 4.
Pages 192-200 (April 2022)
Original article
ADENI-UCI study: Analysis of non-income decisions in ICU as a measure of limitation of life support treatments
Estudio ADENI-UCI: Análisis de las decisiones de no ingreso en UCI como medida de limitación de los tratamientos de soporte vital
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P. Escudero-Achaa, O. Leizaolab, N. Lázaroc, M. Corderod, A.M. Cossíoe, D. Ballesterosf, P. Recenag, A.I. Tizónh, M. Palomoi, M.M. del Campoj, S. Freitak, J. Duertol, N.M. Bilbaom, B. Vidaln, D. González-Romeroo, F. Diaz-Dominguezp, J. Revueltoq, M.L. Blascor, M. Domezains, Mª. de la Concepción Pavía-Pesquerat, O. Rubiou, A. Estellav, A. Pobow, I. Gomez-Acebox, A. González-Castroa,
Corresponding author
, ADENI Study Group. Grupo de trabajo de BIOETICA de la SEMICYUC
a Hospital Universitario Marqués de Valdecilla, Santander, Spain
b Hospital Universitario Central de Asturias, Asturias, Spain
c Hospital 12 de Octubre, Madrid, Spain
d Hospital Universitario de Álava, Vitoria, Spain
e Hospital Universitario Virgen Macarena, Sevilla, Spain
f Hospital Puerta de Hierro, Madrid, Spain
g Hospital Universitario de Cabueñes, Gijón, Spain
h Complexo Hospitalario Universitario de Ourense, Ourense, Spain
i Hospital de Sagunto, Valencia, Spain
j Hospital Universitario Germans Trias i Pujol, Badalona, Spain
k Complexo Hospitalario Universitario Alvaro Cunqueiro, Vigo, Spain
l Hospital Clínico San Carlos, Madrid, Spain
m Hospital Galdakao-Usansolo, Bizkaia, Spain
n Hospital Universitario de Castellón, Castellón, Spain
o Complejo Universitario Insular Materno Infantil, Las Palmas, Spain
p Complejo Asistencial Universitario de León, León, Spain
q Hospital Universitario Puerta del Mar, Cádiz, Spain
r Hospital Clínico de Valencia, Valencia, Spain
s Hospital Universitario de Cruces, Bilbao, Spain
t Hospital San Pedro, Logroño, Spain
u Fundació Althaia Xarxa Universitaria Assistencial de Manresa, Manresa, Spain
v Hospital de Jerez, Jerez, Spain
w Hospital Joan XXIII de Tarragona, Tarragona, Spain
x Departamento de Preventiva y Salud Pública, Facultad de Medicina, Universidad de Cantabria, Santander, Spain
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Figures (1)
Tables (4)
Table 1. Characteristics of 57 of the 62 hospitals and Departments of Intensive Care Medicine participating in the study.
Table 2. Main clinical-epidemiological characteristics of the 2284 patients analyzed in the study.
Table 3. Differences in the characteristics of survivors and non-survivors in the study, and their association to mortality based on triple-level nested logistic regression analysis corrected for age and gender, and the APACHE II and SOFA scores.
Table 4. Associations between the variables related to consultation of the Department of Intensive Care Medicine and mortality based on multilevel nested logistic regression analysis corrected for age and gender, and the APACHE II and SOFA scores.
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Abstract
Objective

To analyze the variables associated with ICU refusal decisions as a life support treatment limitation measure.

Design

Prospective, multicentrico.

Scope

62 ICU from Spain between February 2018 and March 2019.

Patients

Over 18 years of age who were denied entry into ICU as a life support treatment limitation measure.

Interventions

None.

Main interest variables

Patient comorities, functional situation as measured by the KNAUS and Karnosfky scale; predicted scales of Lee and Charlson; severity of the sick person measured by the APACHE II and SOFA scales, which justifies the decision-making, a person to whom the information is transmitted; date of discharge or in-hospital death, destination for hospital discharge.

Results

A total of 2312 non-income decisions were recorded as an LTSV measure of which 2284 were analyzed. The main reason for consultation was respiratory failure (1080 [47.29%]). The poor estimated quality of life of the sick (1417 [62.04%]), the presence of a severe chronic disease (1367 [59.85%]) and the prior functional limitation of patients (1270 [55.60%]) were the main reasons for denying admission. The in-hospital mortality rate was 60.33%. The futility of treatment was found as a risk factor associated with mortality (OR: 3.23; IC95%: 2.62–3.99).

Conclusions

Decisions to limit ICU entry as an LTSV measure are based on the same reasons as decisions made within the ICU. The futility valued by the intensivist is adequately related to the final result of death.

Keywords:
Limitation of life support treatments
Denial of income
Futility
Quality of life
Resumen
Objetivo

Analizar las variables asociadas a las decisiones de rechazo al ingreso en una Unidad de Cuidados Intensivos (UCI) como medida de limitación de tratamiento de soporte vital.

Diseño

Prospectivo, multicéntrico.

Ámbito

Sesenta y dos UCI de España entre febrero de 2018 y marzo de 2019.

Pacientes

Mayores de 18 años a los que se les negó el ingreso a una UCI como medida delimitación de tratamiento de soporte vital.

Intervenciones

Ninguna.

Variables de interés principales

Comorbilidades de los pacientes, situación funcional previa medida por la escala KNAUS y Karnosfky; escalas pronósticas de Lee y Charlson; gravedad del enfermo medida por las escalas APACHE II y SOFA, motivo que justifica la toma de la decisión, persona a la cual es trasmitida la información; fecha de alta o fallecimiento intrahospitalario, destino al alta hospitalaria.

Resultados

Se registraron un total de 2.312 decisiones de no ingreso como medida de limitación del tratamiento de soporte vital (LTSV), de las cuales se analizaron 2.284. El principal motivo de consulta fue la insuficiencia respiratoria (1.080 [47,29%]). La pobre calidad de vida estimada de los enfermos (1.417 [62,04%]), la presencia de una enfermedad crónica grave (1.367 [59,85%]) y la limitación funcional previa de los pacientes (1.270 [55,60%]) fueron los principales motivos esgrimidos para denegar el ingreso. La tasa de mortalidad intrahospitalaria fue del 60,33%. La futilidad del tratamiento se constató como factor de riesgo asociado a mortalidad (OR: 3,23; IC 95%: 2,62–3,99).

Conclusiones

Las decisiones para limitar el ingreso en UCI como medida de LTSV se basan en los mismos motivos que las decisiones tomadas dentro de la UCI. La futilidad valorada por el intensivista se relaciona adecuadamente con el resultado final de muerte.

Palabras clave:
Limitación de los tratamientos de soporte vital
Negación de ingreso
Futilidad
Calidad de vida

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