ArticleIntensive care medicine2015
Respective impact of no escalation of treatment, withholding and withdrawal of life-sustaining treatment on ICU patients' prognosis: a multicenter study of the Outcomerea Research Group.
Article in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 30 papers, 1 of them a synthesis that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
30 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Changes in critically ill cancer patients' short-term outcome over the last decades: results of systematic review with meta-analysis on individual data.Intensive care medicine · 2019Pooled it
- Effect of a condolence letter on grief symptoms among relatives of patients who died in the ICU: a randomized clinical trial.Intensive care medicine · 2017Trial
- Impact of treatment goals on outcomes in critically ill nonagenarians: a retrospective observational study.BMC geriatrics · 2026Observational
- Life-Supporting Treatment Limitations in Patients Who Die Within 48 Hours After ICU Admission: A French, Multicenter, Observational, Exploratory Study.Critical care explorations · 2025Observational
- Self-extubation in critically ill patients: from the French OUTCOMEREA Network.Critical care (London, England) · 2025Article
- Article
- Indian Society of Critical Care Medicine and Indian Association of Palliative Care Expert Consensus and Position Statements for End-of-life and Palliative Care in the Intensive Care Unit.Indian journal of critical care medicine : peer-reviewed, official publication of Indian Society of Critical Care Medicine · 2024Article
- Patient and Hospital Characteristics Associated With the Interhospital Transfer of Adult Patients With Sepsis.Critical care explorations · 2023Article
- Non-ventilator-associated ICU-acquired pneumonia (NV-ICU-AP) in patients with acute exacerbation of COPD: From the French OUTCOMEREA cohort.Critical care (London, England) · 2023Article
- Limitation of life-sustaining therapies in critically ill patients with COVID-19: a descriptive epidemiological investigation from the COVID-ICU study.Critical care (London, England) · 2023Article
- "No Escalation of Treatment" Designations: A Multi-institutional Exploratory Qualitative Study.Chest · 2023Article
- Death in hospital following ICU discharge: insights from the LUNG SAFE study.Critical care (London, England) · 2021Article
- Life Support Limitations in Mechanically Ventilated Stroke Patients.Critical care explorations · 2021Article
- Factors associated with survival of patients with solid Cancer alive after intensive care unit discharge between 2005 and 2013.BMC cancer · 2021Article
- Mortality and Life-Sustaining Therapy Decisions in Patients With Cancer and Acute Respiratory Failure Due to COVID-19 or Other Causes: An Observational Study.Frontiers in medicine · 2021Article
- Impact of advance directives on the variability between intensivists in the decisions to forgo life-sustaining treatment.Critical care (London, England) · 2020Article
- One-year survival in acute stroke patients requiring mechanical ventilation: a multicenter cohort study.Annals of intensive care · 2020Article
- Contemporary strategies to improve clinical trial design for critical care research: insights from the First Critical Care Clinical Trialists Workshop.Intensive care medicine · 2020Article
- Impact of species and antibiotic therapy of enterococcal peritonitis on 30-day mortality in critical care-an analysis of the OUTCOMEREA database.Critical care (London, England) · 2019Article
- Selection and Receipt of Kidney Replacement in Critically Ill Older Patients with AKI.Clinical journal of the American Society of Nephrology : CJASN · 2019Article
Corrections and comments
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Authors and funding
16 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeTo assess the prevalence of decisions to forgo life-sustaining treatment (DFLST), the patients characteristics, and to estimate the impact of DFLST stages on mortality.
methodsObservational study of a prospective database between 2005 and 2012 from 13 ICUs. DFLST were defined as follows: no escalation of treatment (stage 1), not to start or escalate treatment even if such treatment is considered in the future; withholding (stage 2), not to start or escalate necessary treatment; withdrawal (stage 3), to stop necessary treatment. The impact of daily DFLST stage on day-30 hospital mortality was tested with a discrete-time Cox's model and adjusted for admission severity and daily SOFA score.
resultsOf 10,080 patients, 1290 (13%) made DFLST. The highest DFLST stage during the ICU stay was no escalation of treatment in 339 (26%) patients, withholding in 502 (39%) patients, and withdrawal in 449 (35%) patients. Older patients, patients with at least one chronic disease, and patients with greater ICU severity were significantly more numerous in the DFLST group. Day-30 mortality was 13% for non-DFLST patients, 35% for no escalation of treatment, 75% for withholding, 93% for withdrawal. After adjustment, an increase in day-30 mortality was associated with withholding and withdrawal (hazard ratio 95% CI 5.93 [4.95-7.12] and 20.05 [15.58-25.79], P < 0.0001), but not with no escalation of treatment (HR 1.14 [0.91-1.44], P = 0.25).
conclusionsDFLST were made in 13% of ICU patients. Withholding, withdrawal, older age, more comorbidities, and higher severity of illness were associated with higher mortality. No escalation of treatment was not associated with increased mortality.
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