Potentially Inappropriate Treatments in Intensive Care Units (INAPPT-ICU): Point Prevalence Study

Abstract

Objective: Technological advances increased prolonged life expectancy of the terminal patients, who had end-stage diseases. End-of-life care in intensive care units (ICU) has increased with the rise in admissions of terminal patients to ICU. Our aims in this study were to determine the prevalence of terminal patients, and to find the reasons for potentially inappropriate treatments in ICUs. Materials and Methods: It was nationwide, multicenter, point prevalence and observational study. All adult patients, who stayed more than 48 h in the ICU, were enrolled. All patients were recorded on an electronic case record form, consisting of data on patient demographics, treatments, family participation and mini survey for physicians. The study was conducted on October 15, 2018 with a follow-up for 30 days. Results: Of 1127 patients 286 (25%) ICU patients were diagnosed as terminal patients by ICU physicians depending on primary physician statement. Terminal patients relatives requests and physicians legal concerns reduced end-of-life care quality. Terminal patients had significantly increased usage of mechanical ventilation, inotropic drugs, and poor end-of-life care quality (p<0.001). Fifty-four percent of the terminal patients didn’t have any end-of-life decisions at discharge. Half of the terminal patient relatives requested the full code. Without legal concerns, most of the physicians would apply do not resuscitate (86%), withhold (77%) and withdraw (53%) to terminal patients at the end-of-life. Conclusion: Terminal patients occupy an important place in the ICU. To increase the quality of terminal patients’ end-of-life care in the ICU, advanced care planning and legal arrangements should be conducted properly.