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. (C) 2018 Elsevier Inc. All rights reserved.