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This is an observational prospective study that investigates patient-related factors that cannot be accessed in registry data, such as frailty, functional level prior to admission, cognitive impairment, living in a relationship or not, and how these factors influence decisions about treatment limitations and outcome for critically ill patients in Swedish Intensive Care Units.
The purpose of intensive care is to prevent and treat organ failure in one or more major organ systems, with the goal that the patient should have a continued that meaningful life. Due to the aging population, the development of medical knowledge and additional therapies, the number of patients in need of intensive care, worldwide, has increased. The number of patients being treated in intensive care units in Sweden increased by 23 % from 2008 to 2015(1).
Intensive care should be provided based on the patient's condition, needs and available treatment options. In addition, it is important that patients benefit from the treatment. In some circumstances, the patient's chronic and / or acute condition is of such a degree that the patient is not deemed able to benefit from intensive care. In such situations, decisions must be made to withdraw or withhold intensive care . A decision to withdraw or withhold intensive care means that life-sustaining treatments such as mechanical ventilation, dialysis or inotropic drugs is terminated or not initiated .
In a recent study from our group, we showed that female gender increases the odds of making a decision to withdraw or refrain from intensive care by 18% , when adjustments for age and patient condition had been made ( 2 ). The reason for this is not known, but can be found in explanations as to the patient's functional status prior to the current admission, including how well you manage daily activities, if you have any type of functional impairment, cognitive impairment or frailty. Frailty describes a patient's vulnerability , and several scientific reports demonstrate an association between frailty and impaired outcome after intensive care (3).
The impact of preadmission functional status has been shown previously in several studies from Yale University, United States ( 7-9 ). Data this is mainly for an older population, from the US, ( 10-11 ) but for a mixed intensive care population in Sweden there is no such data. A recent study from the VIP2 group has looked at how factors such as frailty , cognitive impairment , functional impairment and comorbidities affect outcome in patients over 80 years of age. It was then found that frailty alone could predict worse outcome (13). Gender and relationships were not parameters in this study.
The purpose of the study is to identify factors that may influence clinical decisions about treatment limitations and outcome.
Sahlgrenska University Hospital
Not yet recruiting
Published on BioPortfolio: 2020-01-21T11:32:36-0500
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A disease or state in which death is possible or imminent.
A study in which observations are made before and after an intervention, both in a group that receives the intervention and in a control group that does not.
The use of severity-of-illness measures, such as age, to estimate the risk (measurable or predictable chance of loss, injury or death) to which a patient is subject before receiving some health care intervention. This adjustment allows comparison of performance and quality across organizations, practitioners, and communities. (from JCAHO, Lexikon, 1994)
A study that uses observations at multiple time points before and after an intervention (the "interruption"), in an attempt to detect whether the intervention has had an effect significantly greater than any underlying trend over time.
An acute or prolonged illness usually considered to be life-threatening or with the threat of serious residual disability. Treatment may be radical and is frequently costly.
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