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 Surgical patients, who had blood transfusions withheld (44.6%), had more ICU-therapies withheld or withdrawn simultaneously than patients who had transfusions maintained (5 ± 2 vs. 2 ± 1, p 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.
Involved external institutions
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.
BibTeX: Download