PMC:29003 / 3882-9166 JSONTXT

{"project":"2_test","denotations":[{"id":"11056711-1335602-23652136","span":{"begin":650,"end":652},"obj":"1335602"},{"id":"11056711-1374002-23652137","span":{"begin":2313,"end":2315},"obj":"1374002"}],"text":"Methods\nBefore the study was started, deaths among patients admitted to the ICU were defined in relation to the type of management before death [19].\n\nDefinitions\nThe patients were placed in groups according to the final outcome: those surviving 1 year after ICU admission (S); death at home after hospital discharge (DH); death in the hospital once discharged from the ICU (DIH); and death in the ICU (DI).\nIn the DI group, the cases were classified into the following subgroups according to the type of management decision taken at the time of death.\nCardiovascular death (CVD): those patients who died despite cardiopulmonary resuscitation (CPR) [20] for at least 30 min, according to hospital guidelines. This group represents a substantial investment in therapeutic resources at the time of death.\nBrain death (BD): those patients where an irreversible loss of cerebral and brainstem function were found, following the guidelines of the Spanish Society of Neurology [21] and of Spanish law [22]. This group represents a large investment in diagnostic resources at the moment of death. Once BD was confirmed, mechanical ventilation was withdrawn or was continued until organ donation was authorized.\nDeath after withholding of life support (DWH; patients in whom it was decided to limit therapy): the most common therapies withheld are CPR in the event of cardiac arrest and dialysis. Less frequently withheld therapeutic measures are mechanical ventilation, laboratory analysis, surgical procedures, administration of antibiotics, parenteral nutrition, blood transfusions, fluid therapy, antiarrhythmic drugs or vasopressors. In our ICU, the withholding of any therapeutic measure besides CPR and dialysis is rare, because either these cases would not be considered to be candidates for admission into the ICU [19], or the withdrawal of therapeutic measures of life support would be considered.\nDeath after the withdrawal of therapeutic life-support measures (DWD; patients in whom a gradual withdrawal of therapeutic resources of life support was carried out, after the previous establishment of withholding measures): initially, nutrition, vasopressor agents and dialysis were withdrawn. Finally, oxygen support was withdrawn and, if necessary, the respiratory frequency and the tidal volume were reduced [24]. The patient was never disconnected from mechanical ventilation, nor was sedation stopped in any case.\n\nDecision-making process\nThe medical team considered the withholding or withdrawing of treatment in each patient without having knowledge of the analyzed severity parameters.\nThe ICU doctor responsible for the patient's care, on their own initiative or after considering a proposal from the patient's family or the head of the department, proposed the need to establish therapeutic restrictions or to withdraw treatment. This opinion was discussed with the other doctors of the service and the nursing staff responsible for the patient. If the proposal was accepted, the relevant doctors from other departments who had sought the patient's admission to the ICU were asked for their opinion and, once a consensus was reached, this was conveyed to the family by the ICU doctor directly responsible for the patient.\nIf at any time the decision was not accepted, the required life-support measures were continued. The ICU doctor on call always respected the decisions reached. Only in rare circumstances did the on-call doctor, in agreement with the admitting doctor, decide, with the family, to withhold treatment before group discussion. The decisions were documented in the patient's notes.\nOnce the patient was discharged to a general ward, the ICU doctor informed the ward doctor about the decisions taken, such as not to return to ICU in case of deterioration in the patient's clinical condition or not to perform CPR.\n\nData collected\nResource utilization was evaluated by measuring the use of mechanical ventilation and the daily TISS in the ICU. The APACHE III on the first day and the daily SOFA were used as indicators of severity. A SOFA score was calculated for each organ system and all scores equal to or greater than 1 were added together to give an indication of the severity of the case. SOFA was not used in this case as an indicator of the severity of sepsis.\nAPACHE III and SOFA were recorded on the first day and also recorded were the mean SOFA value during ICU stay, maximum SOFA score, number of days with the maximum SOFA score, sum of all the SOFA points of the ICU stay, TISS at the first day, mean TISS value during the stay in ICU and sum of all the TISS points of the ICU stay.\n\nInclusion criteria\nAll patients with ICU stay longer than 24 h were included, as were those whose stay was less than 24 h but who needed mechanical ventilation.\n\nStatistics\nWe compared the groups using the Kruskal-Wallis test and the Mann-Whitney rank-sum test, with the Tukey-B test and the Scheffe test correction for between-groups analysis. The qualitative variables were analyzed with the Chi-square test. Differences were considered significant at P \u003c 0.05. Groups with small samples (\u003c 5) were excluded from the statistical analyses. All statistical analyses were performed on a personal computer with the SPSS®7.5 (SPSS Inc, Chicago, Illinois, USA).\n\n"}

{"project":"Colil","denotations":[{"id":"T15","span":{"begin":650,"end":652},"obj":"1335602"},{"id":"T16","span":{"begin":2313,"end":2315},"obj":"1374002"}],"namespaces":[{"prefix":"_base","uri":"http://pubannotation.org/docs/sourcedb/PubMed/sourceid/"}],"text":"Methods\nBefore the study was started, deaths among patients admitted to the ICU were defined in relation to the type of management before death [19].\n\nDefinitions\nThe patients were placed in groups according to the final outcome: those surviving 1 year after ICU admission (S); death at home after hospital discharge (DH); death in the hospital once discharged from the ICU (DIH); and death in the ICU (DI).\nIn the DI group, the cases were classified into the following subgroups according to the type of management decision taken at the time of death.\nCardiovascular death (CVD): those patients who died despite cardiopulmonary resuscitation (CPR) [20] for at least 30 min, according to hospital guidelines. This group represents a substantial investment in therapeutic resources at the time of death.\nBrain death (BD): those patients where an irreversible loss of cerebral and brainstem function were found, following the guidelines of the Spanish Society of Neurology [21] and of Spanish law [22]. This group represents a large investment in diagnostic resources at the moment of death. Once BD was confirmed, mechanical ventilation was withdrawn or was continued until organ donation was authorized.\nDeath after withholding of life support (DWH; patients in whom it was decided to limit therapy): the most common therapies withheld are CPR in the event of cardiac arrest and dialysis. Less frequently withheld therapeutic measures are mechanical ventilation, laboratory analysis, surgical procedures, administration of antibiotics, parenteral nutrition, blood transfusions, fluid therapy, antiarrhythmic drugs or vasopressors. In our ICU, the withholding of any therapeutic measure besides CPR and dialysis is rare, because either these cases would not be considered to be candidates for admission into the ICU [19], or the withdrawal of therapeutic measures of life support would be considered.\nDeath after the withdrawal of therapeutic life-support measures (DWD; patients in whom a gradual withdrawal of therapeutic resources of life support was carried out, after the previous establishment of withholding measures): initially, nutrition, vasopressor agents and dialysis were withdrawn. Finally, oxygen support was withdrawn and, if necessary, the respiratory frequency and the tidal volume were reduced [24]. The patient was never disconnected from mechanical ventilation, nor was sedation stopped in any case.\n\nDecision-making process\nThe medical team considered the withholding or withdrawing of treatment in each patient without having knowledge of the analyzed severity parameters.\nThe ICU doctor responsible for the patient's care, on their own initiative or after considering a proposal from the patient's family or the head of the department, proposed the need to establish therapeutic restrictions or to withdraw treatment. This opinion was discussed with the other doctors of the service and the nursing staff responsible for the patient. If the proposal was accepted, the relevant doctors from other departments who had sought the patient's admission to the ICU were asked for their opinion and, once a consensus was reached, this was conveyed to the family by the ICU doctor directly responsible for the patient.\nIf at any time the decision was not accepted, the required life-support measures were continued. The ICU doctor on call always respected the decisions reached. Only in rare circumstances did the on-call doctor, in agreement with the admitting doctor, decide, with the family, to withhold treatment before group discussion. The decisions were documented in the patient's notes.\nOnce the patient was discharged to a general ward, the ICU doctor informed the ward doctor about the decisions taken, such as not to return to ICU in case of deterioration in the patient's clinical condition or not to perform CPR.\n\nData collected\nResource utilization was evaluated by measuring the use of mechanical ventilation and the daily TISS in the ICU. The APACHE III on the first day and the daily SOFA were used as indicators of severity. A SOFA score was calculated for each organ system and all scores equal to or greater than 1 were added together to give an indication of the severity of the case. SOFA was not used in this case as an indicator of the severity of sepsis.\nAPACHE III and SOFA were recorded on the first day and also recorded were the mean SOFA value during ICU stay, maximum SOFA score, number of days with the maximum SOFA score, sum of all the SOFA points of the ICU stay, TISS at the first day, mean TISS value during the stay in ICU and sum of all the TISS points of the ICU stay.\n\nInclusion criteria\nAll patients with ICU stay longer than 24 h were included, as were those whose stay was less than 24 h but who needed mechanical ventilation.\n\nStatistics\nWe compared the groups using the Kruskal-Wallis test and the Mann-Whitney rank-sum test, with the Tukey-B test and the Scheffe test correction for between-groups analysis. The qualitative variables were analyzed with the Chi-square test. Differences were considered significant at P \u003c 0.05. Groups with small samples (\u003c 5) were excluded from the statistical analyses. All statistical analyses were performed on a personal computer with the SPSS®7.5 (SPSS Inc, Chicago, Illinois, USA).\n\n"}