Evidence map›Paper›PMID 37736783›Full record

Observational studyIntensive care medicine2023

Differences in directives to limit treatment and discontinue mechanical ventilation between elderly and very elderly patients: a substudy of a multinational observational study.

Karen E A Burns, Deborah J Cook, Keying Xu, Peter Dodek, Jesús Villar, Andrew Jones, Farhad N Kapadia, David J Gattas, Scott K Epstein, Paolo Pelosi and 4 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in Intensive care medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
2.0field-weighted citation impact, top 13% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

The trial behind it

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.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed, 7 citations in OpenAlex.

  1. Review
  2. Observational
  3. Article
  4. 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 · 2024
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 12 institutions in 7 countries.

Karen E A BurnsInterdepartmental Division of Critical Care, University of Toronto, Toronto, ON, Canada. karen.burns@unityhealth.to.ORCID 0000-0002-9967-5424
Deborah J CookDepartments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Keying XuLi Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Canada.
Peter DodekDivision of Critical Care Medicine, Centre for Health Evaluation and Outcome Sciences, St Paul's Hospital, Vancouver, BC, Canada.
Jesús VillarCIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain.
Andrew JonesDepartment of Critical Care Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK.
Farhad N KapadiaDepartment of Intensive Care, Hinduja National Hospital, Bombay, India.
David J GattasIntensive Care Unit, Royal Prince Alfred Hospital, University of Sydney, Camperdown, NSW, Australia.
Scott K EpsteinTufts University School of Medicine, Boston, MA, USA.
Paolo PelosiDepartment of Surgical Sciences and Integrated Diagnostics, University of Genoa, Genoa, Italy.
Kallirroi KefalaAnaesthesia, Critical Care and Pain Medicine, Edinburgh Royal Infirmary, Edinburgh, Scotland, UK.
Maureen O MeadeDepartments of Medicine and Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada.
Leena RizviInterdepartmental Division of Critical Care Medicine, Department of Medicine, Unity Health Toronto, St Michael's Hospital, 30 Bond St, Office 4-045 Donnelly Wing, Toronto, ON, M5B 1W8, Canada.
Canadian Critical Care Trials Group
St. Michael's Hospital · CAEdinburgh Royal Infirmary · GBGuy's and St Thomas' NHS Foundation Trust · GBImpact · CAInstituto de Salud Carlos III · ESOspedale Policlinico San Martino · ITP. D. Hinduja Hospital and Medical Research Centre · INSt. Joseph Hospital · USSt Michael's Hospital · GBThe University of Sydney · AUTufts University · USUniversity of British Columbia · CA

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeThe aim of this study was to characterize differences in directives to limit treatments and discontinue invasive mechanical ventilation (IMV) in elderly (65-80 years) and very elderly (> 80 years) intensive care unit (ICU) patients.

methodsWe prospectively described new written orders to limit treatments, IMV discontinuation strategies [direct extubation, direct tracheostomy, spontaneous breathing trial (SBT), noninvasive ventilation (NIV) use], and associations between initial failed SBT and outcomes in 142 ICUs from 6 regions (Canada, India, United Kingdom, Europe, Australia/New Zealand, United States).

resultsWe evaluated 788 (586 elderly; 202 very elderly) patients. Very elderly (vs. elderly) patients had similar withdrawal orders but significantly more withholding orders, especially cardiopulmonary resuscitation and dialysis, after ICU admission [67 (33.2%) vs. 128 (21.9%); p = 0.002]. Orders to withhold reintubation were written sooner in very elderly (vs. elderly) patients [4 (2-8) vs. 7 (4-13) days, p = 0.02]. Very elderly and elderly patients had similar rates of direct extubation [39 (19.3%) vs. 113 (19.3%)], direct tracheostomy [10 (5%) vs. 40 (6.8%)], initial SBT [105 (52%) vs. 302 (51.5%)] and initial successful SBT [84 (80%) vs. 245 (81.1%)]. Very elderly patients experienced similar ICU outcomes (mortality, length of stay, duration of ventilation) but higher hospital mortality [26 (12.9%) vs. 38 (6.5%)]. Direct tracheostomy and initial failed SBT were associated with worse outcomes. Regional differences existed in withholding orders at ICU admission and in withholding and withdrawal orders after ICU admission.

conclusionsVery elderly (vs. elderly) patients had more orders to withhold treatments after ICU admission and higher hospital mortality, but similar ICU outcomes and IMV discontinuation. Significant regional differences existed in withholding and withdrawal practices.

Indexed as

Noninvasive VentilationRespiration, ArtificialAgedAirway ExtubationHumansIntensive Care UnitsRenal DialysisRespirationVentilator WeaningElderlyGoals of careTreatment limitationsWeaning

Identifiers

PMID37736783
OpenAlexW4386944796

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

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.