Limitation to Advanced Life Support in patients admitted to intensive care unit with integrated palliative care.
OBJECTIVE
To estimate the incidence of limitations to Advanced Life Support in critically ill patients admitted to an intensive care unit with integrated palliative care.


METHODS
This retrospective cohort study included patients in the palliative care program of the intensive care unit of Hospital Paulistano over 18 years of age from May 1, 2011, to January 31, 2014. The limitations to Advanced Life Support that were analyzed included do-not-resuscitate orders, mechanical ventilation, dialysis and vasoactive drugs. Central tendency measures were calculated for quantitative variables. The chi-squared test was used to compare the characteristics of patients with or without limits to Advanced Life Support, and the Wilcoxon test was used to compare length of stay after Advanced Life Support. Confidence intervals reflecting p ≤ 0.05 were considered for statistical significance.


RESULTS
A total of 3,487 patients were admitted to the intensive care unit, of whom 342 were included in the palliative care program. It was observed that after entering the palliative care program, it took a median of 2 (1 - 4) days for death to occur in the intensive care unit and 4 (2 - 11) days for hospital death to occur. Many of the limitations to Advanced Life Support (42.7%) took place on the first day of hospitalization. Cardiopulmonary resuscitation (96.8%) and ventilatory support (73.6%) were the most adopted limitations.


CONCLUSIONS
The contribution of palliative care integrated into the intensive care unit was important for the practice of orthothanasia, i.e., the non-extension of the life of a critically ill patient by artificial means.
Unidade de Terapia Intensiva, Hospital Paulistano, São Paulo, SP, Brazil.
Sandra Regina Gonzaga
SR
Mazutti
Departamento de Saúde Coletiva, Faculdade de Ciências Médicas, Santa Casa de São Paulo, São Paulo, SP, Brazil.
Andréia de Fátima
AF
Nascimento
Unidade de Terapia Intensiva, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
Renata Rego Lins
RR
Fumis
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data; D015331:Cohort Studies; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008020:Life Support Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010166:Palliative Care / Q000458:organization & administration*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D013997:Time Factors