Changes in limitations of life‐sustaining treatments over time in a French intensive care unit: A prospective observational study

Background: Variability exists between ICUs in the limitations of therapy. Moreover practices may evolve over time. This single‐center observational study aimed to compare withholding or withdrawing practices between 2012 and 2016. Methods: For each period and patient concerned by limitations, withholding “do‐not start”, withholding “do‐not‐increase” and withdrawal measures were recorded. Results: At a four‐year interval, the rate of patients undergoing withholding or withdrawal rose from 10 to 23% and 4 to 7%, respectively. The proportion of patients dying in the ICU with previous limitations increased (53 to 89%), as did patients discharged alive despite withholding instructions (12 to 36%). The overall mortality (28%) was stable over time as the rate of failed resuscitation attempt declined (47 to 11%). In 2016 vs 2012, limitations started earlier following admission: 1 vs 7 days for withholding” do‐not‐start”, 4 vs 8 for withholding “do‐not‐increase”, 4 vs 7 for withdrawal. Notwithstanding the outcome and limitations applied, the median length of ICU stay of patients involved dropped from 13 days in 2012 to 8 days in 2016. Conclusion: A timely inclination to forego hopeless treatments resulted in a lower rate of failed resuscitations before death without change in global mortality. HighlightsTreatment limitations are increasingly common and occurred earlier during ICU stay.Patient's wishes regarding end‐of‐life care should be better addressed by caregivers.Advance care planning reduces both ICU stay and the rate of failed resuscitations.

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