POTENTIALLY INAPPROPRIATE TREATMENTS IN INTENSIVE CARE UNITS (INAPPT-ICU): POINT PREVALENCE STUDY
Elif ERDOGAN, Hulya SUNGURTEKIN, Dilek MEMIS, Demet TOK, Hilal AYOGLU, Ferruh AYOGLU, Isil OZKOCAK TURAN, Cetin KAYMAK, Dilek DAI OZCENGIZ, Mustafa Kemal BAYAR, Yalim DIKMEN
BACKGROUND: Intensive care units (ICU) are facilities for critically ill and terminal patients (TP). With the increased number of admission of TP, end-of-life (EOL) care in ICU is increased. Primary aim of this study is to find the prevalence of TP in ICU, and to compare treatments applied to terminal and non-terminal patients.
METHODS: The study was a nationwide, multicenter, observational, point prevalence study conducted on October 15, 2018 with a follow up for 30 days. The end date of the study was November 14, 2018. Data pertaining all adult patients, who stayed more than 48 hours, were recorded on an electronic case record form. Case record form consisted of data on patient demographics, severity of illness on admission and on the study date, treatments in the last 24 hours, family participation and physician opinion on EOL decisions for that patient. For every patient, physicians indicated whether they consider the patient as terminal or not.
RESULTS: Of all recorded 1127 patients, 25% (n=286) were indicated as terminal, with significantly increased utilization of mechanical ventilation, inotropic drugs, and poor EOL care quality (p<0.001). Fifty four percent of the TP did not have any EOL decisions at discharge. We asked physicians about EOL decisions what they would apply to their TP if they did not have any legal concerns. Most of them (86%) would apply DNR, 77% would apply withhold, and 53% would apply withdraw.
CONCLUSION: TP occupy an important place in ICUs. In order to increase the quality of terminal patients EOL care in ICUs, EOL decisions should be made in accordance with the expectations and desires of the patients.
|