ArticleIntensive care medicine2016
Effect of ICU strain on timing of limitations in life-sustaining therapy and on death.
Article in Intensive care medicine, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 38 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
38 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Indicators of intensive care unit capacity strain: a systematic review.Critical care (London, England) · 2018Pooled it
- Improving racial disparities in unmet palliative care needs among intensive care unit family members with a needs-targeted app intervention: The ICUconnect randomized clinical trial.Contemporary clinical trials · 2021Trial
- In-Hospital Cardiac Resuscitation During Widespread Resident Resignations in South Korea.JAMA network open · 2026Article
- Early decision effect of withholding and/or withdrawing life-sustaining treatment on emergency department patients' short- and long-term outcomes: a retrospective analysis.BMC emergency medicine · 2026Observational
- The effect of shared decision-making for critically ill patients: a systematic review and meta-analysis.Frontiers in medicine · 2026Review
- Practice and Predictors of Do-Not-Resuscitate Orders in a Tertiary-Care Intensive Care Unit in Saudi Arabia.Critical care research and practice · 2024Article
- A Data-Driven Analysis of Ward Capacity Strain Metrics That Predict Clinical Outcomes Among Survivors of Acute Respiratory Failure.Journal of medical systems · 2023Article
- Forecasting ICU Census by Combining Time Series and Survival Models.Critical care explorations · 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
- Among-Hospital Variation in Intensive Care Unit Admission Practices and Associated Outcomes for Patients with Acute Respiratory Failure.Annals of the American Thoracic Society · 2023Article
- Article
- Characterizing Equity of Intensive Care Unit Admissions for Sepsis and Acute Respiratory Failure.Annals of the American Thoracic Society · 2022Article
- Care of the Seriously Ill Patient with SARS-CoV-2.The Medical clinics of North America · 2022Review
- SWEAT ICU-An Observational Study of Physician Workload and the Association of Physician Outcomes in Academic ICUs.Critical care explorations · 2022Article
- A critical care outreach team under strain - Evaluation of the service provided to patients with haematological malignancy during the Covid-19 pandemic.Journal of critical care · 2022Article
- Exploratory analysis of novel electronic health record variables for quantification of healthcare delivery strain, prediction of mortality, and prediction of imminent discharge.Journal of the American Medical Informatics Association : JAMIA · 2022Article
- Derivation and performance of an end-of-life practice score aimed at interpreting worldwide treatment-limiting decisions in the critically ill.Critical care (London, England) · 2022Observational
- Article
- Hospital Capacity Strain as a Window into the Value of ICU Admission: Some Answers, More Questions.American journal of respiratory and critical care medicine · 2022Article
- Prognosticating Outcomes and Nudging Decisions with Electronic Records in the Intensive Care Unit Trial Protocol.Annals of the American Thoracic Society · 2021Article
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4 authors.
Funding
Abstract
purposeThe effect of capacity strain in an ICU on the timing of end-of-life decision-making is unknown. We sought to determine how changes in strain impact timing of new do-not-resuscitate (DNR) orders and of death.
methodsRetrospective cohort study of 9891 patients dying in the hospital following an ICU stay ≥72 h in Project IMPACT, 2001-2008. We examined the effect of ICU capacity strain (measured by standardized census, proportion of new admissions, and average patient acuity) on time to initiation of DNR orders and time to death for all ICU decedents using fixed-effects linear regression.
resultsIncreases in strain were associated with shorter time to DNR for patients with limitations in therapy (predicted time to DNR 6.11 days for highest versus 7.70 days for lowest quintile of acuity, p = 0.02; 6.50 days for highest versus 7.77 days for lowest quintile of admissions, p < 0.001), and shorter time to death (predicted time to death 7.64 days for highest versus 9.05 days for lowest quintile of admissions, p < 0.001; 8.28 days for highest versus 9.06 days for lowest quintile of census, only in closed ICUs, p = 0.006). Time to DNR order significantly mediated relationships between acuity and admissions and time to death, explaining the entire effect of acuity, and 65 % of the effect of admissions. There was no association between strain and time to death for decedents without a limitation in therapy.
conclusionsStrains in ICU capacity are associated with end-of-life decision-making, with shorter times to placement of DNR orders and death for patients admitted during high-strain days.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.