Evidence map›Paper›PMID 37884827›Full record

ArticleAnnals of intensive care2023

Limiting life-sustaining treatment for very old ICU patients: cultural challenges and diverse practices.

Michael Beil, Peter Vernon van Heerden, Gavin M Joynt, Stephen Lapinsky, Hans Flaatten, Bertrand Guidet, Dylan de Lange, Susannah Leaver, Christian Jung, Daniel Neves Forte and 4 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Annals of intensive care, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed
–field-weighted citation impact
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

18 citing papers in PubMed.

  1. Trial
  2. Article
  3. Review
  4. Article
  5. Review
  6. Article
  7. Observational
  8. Article
  9. Article
  10. Article
  11. Article
  12. Article
  13. Review
  14. Review
  15. Review
  16. Review
  17. Review
  18. 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.

Michael BeilDepartment of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Peter Vernon van HeerdenGeneral Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.
Gavin M JoyntDepartment of Anaesthesia and Intensive Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
Stephen LapinskyIntensive Care Unit, Mount Sinai Hospital, University of Toronto, Toronto, Canada.
Hans FlaattenDepartment of Research and Development, Haukeland University Hospital, Bergen, Norway.
Bertrand GuidetINSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, AP-HP, Hôpital Saint Antoine, Service MIR, Sorbonne Université, Paris, France.
Dylan de LangeDepartment of Intensive Care Medicine, University Medical Center, University Utrecht, Utrecht, The Netherlands.
Susannah LeaverGeneral Intensive Care, St George's University Hospitals NHS Foundation Trust, London, UK.
Christian JungDepartment of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany.
Daniel Neves ForteHospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Du BinMedical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
Muhammed ElhadiFaculty of Medicine, University of Tripoli, Tripoli, Libya.
Wojciech SzczeklikCenter for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Ul. Wrocławska 1-3, 30 - 901, Kraków, Poland. wojciech.szczeklik@uj.edu.pl.ORCID http://orcid.org/0000-0002-1349-1123
Sigal SviriDepartment of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundDecisions about life-sustaining therapy (LST) in the intensive care unit (ICU) depend on predictions of survival as well as the expected functional capacity and self-perceived quality of life after discharge, especially in very old patients. However, prognostication for individual patients in this cohort is hampered by substantial uncertainty which can lead to a large variability of opinions and, eventually, decisions about LST. Moreover, decision-making processes are often embedded in a framework of ethical and legal recommendations which may vary between countries resulting in divergent management strategies.

methodsBased on a vignette scenario of a multi-morbid 87-year-old patient, this article illustrates the spectrum of opinions about LST among intensivsts with a special interest in very old patients, from ten countries/regions, representing diverse cultures and healthcare systems.

resultsThis survey of expert opinions and national recommendations demonstrates shared principles in the management of very old ICU patients. Some guidelines also acknowledge cultural differences between population groups. Although consensus with families should be sought, shared decision-making is not formally required or practised in all countries.

conclusionsThis article shows similarities and differences in the decision-making for LST in very old ICU patients and recommends strategies to deal with prognostic uncertainty. Conflicts should be anticipated in situations where stakeholders have different cultural beliefs. There is a need for more collaborative research and training in this field.

Indexed as

Critical careEnd of lifeGuidelinesIntensive care unitWithdrawingWithholding

Identifiers

PMID37884827
PMCPMC10603016

What OpenQuestion holds

Textmetadata
LicenceCC BY
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.