Outcome in patients perceived as receiving excessive care across different ethical climates: a prospective study in 68 intensive care units in Europe and the USA

• DOI: 10.1007/s00134-018-5231-8
• Publication Date: 2018-05-28T09:52:50Z
• Authors: D. D. Benoit; H. I. Jensen; J. Malmgren; V. Metaxa; A. K. Reyners; M. Darmon; K. Rusinova; D. Talmor; A. P. Meert; L. Cancelliere; L. Zubek; P. Maia; A. Michalsen; S. Vanheule; E. J. O. Kompanje; J. Decruyenaere; S. Vandenberghe; S. Vansteelandt; B. Gadeyne; B. Van den Bulcke; E. Azoulay; R. D. Piers
• Keywords: Pain medicine

Whether the quality of ethical climate in intensive care unit (ICU) improves identification patients receiving excessive and affects patient outcomes is unknown. In this prospective observational study, perceptions (PECs) by clinicians working 68 ICUs Europe USA were collected daily during a 28-day period. The was assessed via validated questionnaire. We compared combined endpoint (death, not at home or poor life 1 year) with PECs time from until written treatment-limitation decisions (TLDs) death across four climates defined cluster analysis. Of 4747 eligible clinicians, 2992 (63%) evaluated their ICU. 321 623 admitted for monitoring only good (n = 12, 18%) 24, 35%) climate, 36 (11%) 74 (12%), respectively identified least two clinicians. 35 71 an available endpoint, 100% (95% CI 90.0–1.00) 85.9% (75.4–92.0) (P 0.02) attained that endpoint. risk (HR 1.88, 95% 1.20–2.92) TLD 2.32, 1.11–4.85) higher than those one. differences between average without 20, 29%) nursing involvement end life, less obvious but still favour former. Enhancing ICU may improve both decision-making process life.