Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design and Setting
2.2. Data Sources
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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All (n = 373) | COVID-19 (n = 72) | Non-COVID-19 (n = 301) | p-Value | ||||
---|---|---|---|---|---|---|---|
Age, years, mean (±SD) | 68.88 | (15.13) | 65.85 | (±13.68) | 69.61 | (±15.39) | 0.015 |
Gender, male, n (%) | 218 | (58.4) | 54 | (75.0) | 164 | (54.5) | 0.002 |
Urgency of admission, n (%) | |||||||
Elective | 10 | (2.7) | - | - | 10 | (3.3) | <0.001 |
Unplanned | 26 | (7.0) | 15 | (20.8) | 11 | (3.7) | |
Emergency | 337 | (90.3) | 57 | (79.2) | 280 | (93.0) | |
Severity scores, mean (±SD) | |||||||
APACHE II | 31.24 | (8.88) | 30.49 | (±9.08) | 31.42 | (±8.84) | 0.479 |
SAPS2 | 69.14 | (18.65) | 70.97 | (±17.84) | 68.70 | (±18.85) | 0.174 |
ICU-LOS, days, mean (±SD) | 10.35 | (14.36) | 19.35 | (±22.35) | 8.20 | (±10.65) | <0.001 |
EOLD, n (%) | 319 | (85.5) | 60 | (83.3) | 259 | (86.0) | 0.577 |
Advance directive, n (%) | 83 | (22.3) | 15 | (20.8) | 68 | (22.6) | 0.757 |
Precautionary power of attorney, n (%) | 92 | (24.7) | 17 | (23.6) | 75 | (24.9) | 0.880 |
Comorbidity, n (%) | All (n = 373) | COVID-19 (n = 72) | Non-COVID-19 (n = 301) | p-Value | |||
---|---|---|---|---|---|---|---|
Liver cirrhosis | 28 | (7.5) | 4 | (5.6) | 24 | (8.0) | 0.622 |
Portal hypertension | 13 | (3.5) | 3 | (4.2) | 10 | (3.3) | 0.722 |
Status post esophageal bleeding | 5 | (1.3) | 1 | (1.4) | 4 | (1.3) | 1.000 |
Hepatic encephalopathy | 5 | (1.3) | 1 | (1.4) | 4 | (1.3) | 1.000 |
Heart failure NYHA IV | 31 | (8.3) | 4 | (5.6) | 24 | (9.0) | 0.477 |
Chronic pulmonary disease | 72 | (19.3) | 13 | (18.1) | 59 | (19.6) | 0.869 |
Chronic obstructive pulmonary disease (COPD) | 56 | (15.0) | 6 | (8.3) | 50 | (16.6) | 0.097 |
Lung fibrosis | 8 | (2.1) | 1 | (1.4) | 7 | (2.3) | 1.000 |
Terminal renal insufficiency | 16 | (4.3) | 1 | (1.4) | 15 | (5.0) | 0.327 |
Steroid medication | 15 | (4.0) | 2 | (2.8) | 13 | (4.3) | 0.745 |
Chemotherapy | 11 | (2.9) | 0 | (-) | 11 | (3.7) | 0.133 |
Immunosuppression therapy | 15 | (4.0) | 3 | (4.2) | 12 | (4.0) | 1.000 |
HIV-Infection status positive | 0 | (-) | 0 | (-) | 0 | (-) | - |
Leukemia | 11 | (2.9) | 0 | (-) | 11 | (3.7) | 0.133 |
Lymphoma | 10 | (2.7) | 3 | (4.2) | 7 | (2.3) | 0.414 |
Metastatic cancer | 41 | (11.0) | 2 | (2.8) | 39 | (13.0) | 0.011 |
ICU Therapies, n (%) | All (n = 373) | COVID-19 (n = 72) | Non-COVID-19 (n = 301) | p-Value | |||
---|---|---|---|---|---|---|---|
Tracheostomy | 53 | (14.2) | 23 | (31.9) | 30 | (10.0) | <0.001 |
Mechanical ventilation | 347 | (93.0) | 71 | (98.6) | 276 | (91.7) | 0.038 |
ECMO Therapy | 56 | (15.0) | 27 | (37.5) | 29 | (9.6) | <0.001 |
Renal replacement therapy | 129 | (34.6) | 43 | (59.7) | 86 | (28.6) | <0.001 |
Mechanical ventilation at EOLD | 259 | (69.4) | 54 | (75.0) | 205 | (68.1) | 0.260 |
Renal replacement therapy at EOLD | 93 | (24.9) | 30 | (41.7) | 63 | (20.9) | <0.001 |
EOLD Process, n (%) | All (n = 319) | COVID-19 (n = 60) | Non-COVID-19 (n = 259) | p-Value | |||
---|---|---|---|---|---|---|---|
DNR | 284 | (89.0) | 51 | (85.0) | 233 | (90.0) | 0.358 |
WH/WDLS | 292 | (91.5) | 54 | (90.0) | 238 | (91.6) | 0.797 |
Advance directive | 82 | (25.7) | 15 | (25.0) | 67 | (25.9) | 1.000 |
Precautionary power of attorney | 88 | (27.6) | 16 | (26.7) | 72 | (27.8) | 0.875 |
Successive decision from DNR to WH/WDLS | 22 | (6.9) | 8 | (13.3) | 14 | (5.4) | 0.044 |
Multi-step approach for WH/WDLS | 174 | (54.6) | 38 | (63.3) | 136 | (52.5) | 0.151 |
Shift of EOLD, n (%) | |||||||
Core working time | 177 | (55.5) | 31 | (51.7) | 146 | (56.4) | 0.585 |
Late shift | 106 | (33.2) | 20 | (33.3) | 86 | (33.2) | |
Night shift | 36 | (11.3) | 9 | (15.0) | 27 | (10.4) | |
Physicians responsible in EOLD, n (%) | |||||||
Senior Attending | 288 | (90.3) | 54 | (90.0) | 234 | (90.3) | 1.000 |
Junior Attending/Fellow | 57 | (17.9) | 26 | (43.3) | 31 | (12.0) | <0.001 |
Resident | 83 | (26.0) | 14 | (23.3) | 69 | (26.6) | 0.629 |
Attending-associated specialty | 77 | (24.1) | 12 | (20.0) | 65 | (25.1) | 0.504 |
EOLD Communication, n (%) | All (n = 319) | COVID-19 (n = 60) | Non-COVID-19 (n = 259) | p-Value | |||
---|---|---|---|---|---|---|---|
Patient participated in EOLD | 17 | (5.3) | 1 | (1.7) | 16 | (6.2) | 0.475 |
Patient was informed of EOLD | 13 | (4.1) | 1 | (1.7) | 12 | (4.6) | 0.213 |
Family/Surrogate decision maker participated in EOLD | 205 | (64.3) | 31 | (51.7) | 174 | (67.2) | 0.026 |
Family/Surrogate decision maker was informed of EOLD | 282 | (88.4) | 54 | (90.0) | 228 | (88.0) | 0.824 |
Documentation in PDMS special section, n (%) | |||||||
Legal documents | 149 | (46.7) | 44 | (73.3) | 105 | (40.5) | <0.001 |
Content of family conferences | 195 | (61.1) | 48 | (80.0) | 147 | (56.8) | 0.001 |
Detailed EOLD process | 201 | (63.0) | 42 | (70.0) | 159 | (61.4) | 0.237 |
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Marsch, F.; Spies, C.D.; Francis, R.C.E.; Graw, J.A. Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience. Int. J. Environ. Res. Public Health 2022, 19, 15015. https://doi.org/10.3390/ijerph192215015
Marsch F, Spies CD, Francis RCE, Graw JA. Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience. International Journal of Environmental Research and Public Health. 2022; 19(22):15015. https://doi.org/10.3390/ijerph192215015
Chicago/Turabian StyleMarsch, Fanny, Claudia D. Spies, Roland C. E. Francis, and Jan A. Graw. 2022. "Standardized High-Quality Processes for End-of-Life-Decision Making in the Intensive Care Unit Remain Robust during an Unprecedented New Pandemic—A Single-Center Experience" International Journal of Environmental Research and Public Health 19, no. 22: 15015. https://doi.org/10.3390/ijerph192215015