End-of-life decisions in surgical intensive care medicine - the relevance of blood transfusions
Graw JA, Spies CD, Wernecke KD, Braun JP (2016)
Publication Type: Journal article
Publication year: 2016
Journal
Book Volume: 54
Pages Range: 416-420
Journal Issue: 3
DOI: 10.1016/j.transci.2016.03.005
Abstract
Background: End-of-life decisions (EOLDs) are common in the intensive care unit (ICU). EOLDs underlie a dynamic process and limitation of ICU-therapies is often done sequentially. Questionnaire-based and observational studies on medical ICUs and in palliative care reveal blood transfusions as the first therapy physicians withhold as an EOLD. Methods: To test whether this practice also applies to surgical ICU-patients, in an observational study, all deceased patients (n = 303) admitted to an academic surgical ICU in a three-year period were analyzed for the process of limiting ICU-therapies. Results: Restriction of further surgery (85.4%) and limiting doses of vasopressors (75.8%) were the most frequent forms of limitations in surgical ICU therapies. Surgical patients, who had blood transfusions withheld (44.6%), had more ICU-therapies withheld or withdrawn simultaneously than patients who had transfusions maintained (5 ± 2 vs. 2 ± 1, p < 0.001). Secondary EOLDs and subsequent limitations occurred less frequently in patients who had transfusions withheld with their first EOLD (17.1% vs. 35.6%, p < 0.05). Conclusion: Limitation orders for blood transfusions are not a prioritized decision in EOLDs of surgical ICU patients. Withholding blood transfusions correlates with discontinuation of further significant life-support therapies. This suggests that EOLDs to withhold blood transfusions are part of the most advanced limitations of therapy on the surgical ICU.
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Germany (DE)How to cite
APA:
Graw, J.A., Spies, C.D., Wernecke, K.D., & Braun, J.P. (2016). End-of-life decisions in surgical intensive care medicine - the relevance of blood transfusions. Transfusion and Apheresis Science, 54(3), 416-420. https://doi.org/10.1016/j.transci.2016.03.005
MLA:
Graw, Jan A., et al. "End-of-life decisions in surgical intensive care medicine - the relevance of blood transfusions." Transfusion and Apheresis Science 54.3 (2016): 416-420.
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