Dataset Information

Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

ABSTRACT:

Background

Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe.

Objectives

The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic.

Methods

A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 1573; Northern Europe: n = 821; Southern Europe: n = 711). Generalised estimation equations were used to calculate adjusted odds ratios (aORs) to population averages. Data were adjusted for patient-specific variables (demographic, disease-specific) and health economic data (gross domestic product, health expenditure per capita). The primary outcome was any treatment limitation, and 90-day mortality was a secondary outcome.

Results

The frequency of the primary endpoint (treatment limitation) was highest in Northern Europe (48%), intermediate in Central Europe (39%) and lowest in Southern Europe (24%). The likelihood for treatment limitations was lower in Southern than in Central Europe (aOR 0.39; 95% confidence interval [CI] 0.21-0.73; p = 0.004), even after multivariable adjustment, whereas no statistically significant differences were observed between Northern and Central Europe (aOR 0.57; 95%CI 0.27-1.22; p = 0.15). After multivariable adjustment, no statistically relevant mortality differences were found between Northern and Central Europe (aOR 1.29; 95%CI 0.80-2.09; p = 0.30) or between Southern and Central Europe (aOR 1.07; 95%CI 0.66-1.73; p = 0.78).

Conclusion

This study shows a north-to-south gradient in rates of treatment limitation in Europe, highlighting the heterogeneity of EoLC practices across countries. However, mortality rates were not affected by these results.

SUBMITTER: Wernly B

PROVIDER: S-EPMC9115222 | biostudies-literature | 2022 Sep

REPOSITORIES: biostudies-literature

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Publications

Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

Wernly Bernhard B Rezar Richard R Flaatten Hans H Beil Michael M Fjølner Jesper J Bruno Raphael R RR Artigas Antonio A Pinto Bernardo B BB Schefold Joerg C JC Kelm Malte M Sigal Sviri S van Heerden Peter V PV Szczeklik Wojciech W Elhadi Muhammed M Joannidis Michael M Oeyen Sandra S Wolff Georg G Marsh Brian B Andersen Finn H FH Moreno Rui R Leaver Susannah S Wernly Sarah S Boumendil Ariane A De Lange Dylan W DW Guidet Bertrand B Jung Christian C

Journal of internal medicine 20220422 3

<h4>Background</h4>Previous studies reported regional differences in end-of-life care (EoLC) for critically ill patients in Europe.<h4>Objectives</h4>The purpose of this post-hoc analysis of the prospective multicentre COVIP study was to investigate variations in EoLC practices among older patients in intensive care units during the coronavirus disease 2019 pandemic.<h4>Methods</h4>A total of 3105 critically ill patients aged 70 years and older were enrolled in this study (Central Europe: n = 15 ...[more]

PMID: 35398948

Similar Datasets

Project description:BackgroundThe death rate in intensive care units (ICUs) can reach 20%. More than half occurs after a decision of care withholding/withdrawal. We aimed at describing and evaluating the experience of ICU physicians and nurses involved in the end-of-life (EOL) procedure. Primary objective was the evaluation of the experience of EOL assessed by the CAESAR questionnaire. Secondary objectives were to describe factors associated with a low or high score and to examine the association between Numeric Analogic Scale and quality of EOL.MethodsConsecutive adult patients deceased in 52 ICUs were included between April and June 2018. Characteristics of patients and caregivers, therapeutics and care involved after withdrawal were recorded. CAESAR score included 15 items, rated from 1 (traumatic experience) to 5 (comforting experience). The sum was rated from 15 to 75 (the highest, the best experience). Numeric Analogic Scale was rated from 0 (worst EOL) to 10 (optimal EOL).ResultsFive hundred and ten patients were included, 403 underwent decision of care withholding/withdrawal, and among them 362 underwent effective care withdrawal. Among the 510 patients, mean CAESAR score was 55/75 (± 6) for nurses and 62/75 (± 5) for physicians (P < 0.001). Mean Numeric Analogic Scale was 8 (± 2) for nurses and 8 (± 2) for physicians (P = 0.06). CAESAR score and Numeric Analogic Scale were significantly but weakly correlated. They were significantly higher for both nurses and physicians if the patient died after a decision of withholding/withdrawal. In multivariable analysis, among the 362 patients with effective care withdrawal, disagreement on the intensity of life support between caregivers, non-invasive ventilation and monitoring and blood tests the day of death were associated with lower score for nurses. For physicians, cardiopulmonary resuscitation the day of death was associated with lower score in multivariable analysis.ConclusionExperience of EOL was better in patients with withholding/withdrawal decision as compared to those without. Our results suggest that improvement of nurses' participation in the end-of-life process, as well as less invasive care, would probably improve the experience of EOL for both nurses and physicians. Registration: ClinicalTrial.gov: NCT03392857.

Dataset Information

Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

Background

Objectives

Methods

Results

Conclusion

Publications

Variations in end-of-life care practices in older critically ill patients with COVID-19 in Europe.

Similar Datasets

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