Original scientific paper
https://doi.org/10.3325/cmj.2024.65.37 3
Limitations of life-sustaining treatments in intensive care units in Croatia: a multicenter retrospective study
Diana Špoljar
; Community Health Center Zagreb – Center, Zagreb, Croatia
*
Radovan Radonić
; Division of Intensive Care Medicine, Department of Internal Medicine, University Hospital Centre Zagreb, Zagreb, Croatia
Zdravka Poljaković
; Department of Neurology, University Hospital Center Zagreb, Zagreb, Croatia
Višnja Nesek
; Sveti Duh University Hospital Center, Zagreb, Croatia
Marinko Vučić
; Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
Jasminka Peršec
; Department of Anesthesiology, Reanimatology and Intensive Care Medicine,
Tatjana Kereš
; Intensive Care Unit, Dubrava University Hospital, Zagreb, Croatia
Nenad Karanović
; University Hospital Center Split, Split, Croatia
Krešimir Čaljkušić
; University Hospital Center Split, Split, Croatia
Željko Župan
; Department of Anesthesiology, Reanimatology and Intensive Care Medicine, Faculty of Medicine, University of Rijeka, Rijeka, Croatia
Igor Grubješić
; University Hospital Center Split, Split, Croatia
Mia Golubić
; Zabok General Hospital, Zabok, Croatia
Ana Jozepović
; School of Medicine, University of Zagreb, Zagreb, Croatia
Bojana Nevajdić
; Marien Hospital Dusseldorf, Dusseldorf, Germany
Ana Borovečki
; Andrija Štampar School of Public Health, School of Medicine, University of Zagreb, Zagreb, Croatia
Dinko Tonković
; University Hospital Centre Zagreb, Zagreb, Croatia
* Corresponding author.
Abstract
Aim In order to gain insight into the current prevailing
practices regarding the limitation of life-sustaining treat
-
ment in intensive care units (ICUs) in Croatia, we assessed
the frequency of limitation and provision of certain treat
-
ment modalities, as well as the associated patient and ICUrelated factors.
Methods A multicenter retrospective cross-sectional
study was conducted in 17 ICUs in Croatia. We reviewed
the medical records of patients deceased in 2017 and ex
-
tracted data on demographic, clinical, and health care
variables. A logistic regression analysis was conducted to
determine the associations between these variables and
treatment modalities.
Results The study enrolled 1095 patients (55% male; mean
age 69.9
±13.7). Analgesia and sedation were discontinued
before the patient’s death in 23% and 34% of the cases,
respectively. Patients older than 71 years were less often
mechanically ventilated (
P
<0.001), and less frequently re
-
ceived inotropes and vasoactive therapy (
P
=0.002) than
younger patients. Patients hospitalized in the ICU for less
than 7 days less frequently had discontinuation of me
-
chanical ventilation and inotropes and vasoactive therapy
than patients hospitalized for 8 days and longer (
P
<0.001).
Logistic regression analysis showed that ICU type was a
crucial determinant, with multidisciplinary and surgical
ICUs being associated with higher odds of intubation, me
-
chanical ventilation, vasoactive and inotropic therapy, an
-
algesia, and sedation.
Conclusion Older patients and those diagnosed with
stroke and intracranial hemorrhage received fewer thera
-
peutic modalities. All the observed treatment modalities
were more frequently discontinued in patients who were
hospitalized in the ICU for a prolonged time.
Keywords
Hrčak ID:
336478
URI
Publication date:
20.8.2024.
Visits: 36 *