End-of-life decision-making in respiratory intermediate care units: a European survey.
A survey was performed on behalf of the European Respiratory Society to assess end-of-life practices in patients admitted to European respiratory intermediate care units and high dependency units over a 6-month period. A 33-item questionnaire was sent by e-mail to physicians throughout Europe and the response rate was 28 (29.5%) out of 95. A total of 6,008 patients were admitted and an end-of-life decision was taken in 1,292 (21.5%). The mortality rate in these patients was 68% (884 out of 1,292). The patients received similar proportions of withholding of treatment (298 (23%) out of 1292), do-not-resuscitate or do-not-intubate orders (442 (34%) out of 1,292) and noninvasive mechanical ventilation as the ceiling of ventilatory care (402 (31%) out of 1,292). Withdrawal of therapy was employed in 149 (11%) out of 1,292 patients and euthanasia in one. Do-not-intubate/do-not-resuscitate orders were more frequently used in North compared with South Europe. All of the 473 competent patients directly participated in the decision, whereas, in 722 (56%) out of 1,292 cases, decision-making was reported to be shared with the nurses. In European respiratory intermediate care units and high dependency units, an end-of-life decision is taken for 21.5% of patients admitted. Withholding of treatment, do-not-intubate/do-not-resuscitate orders and noninvasive mechanical ventilation as the ventilatory care ceiling are the most common procedures. Competent patients are often involved, together with nurses.
Nava
S
S
Respiratory Intensive Care Unit, Fondazione S.Maugeri, I.R.C.C.S., Istituto Scientifico di Pavia, Via Maugeri 10, 27100 Pavia, Italy. snava@fsm.it
Sturani
C
C
Hartl
S
S
Magni
G
G
Ciontu
M
M
Corrado
A
A
Simonds
A
A
D000328:Adult; D001291:Attitude of Health Personnel; D003657:Decision Making; D004992:Ethics, Medical; D005060:Europe; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010820:Physicians; D012124:Respiratory Care Units; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D013727:Terminal Care / Q000379:methods* / Q000639:trends; D028761:Withholding Treatment