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Minerva Anestesiologica 2017 July;83(7):728-36

DOI: 10.23736/S0375-9393.17.11711-6


language: English

End-of-life decisions in 34 Slovene Intensive Care Units: a nationwide prospective clinical study

Miha ORAZEM 1, Urh GROSELJ 2, Manca STOJAN 3, Neza MAJDIC 4, Gaj VIDMAR 3, 4, 5, Stefan GROSEK 3, 6

1 Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia; 2 Department of Pediatric Endocrinology, Diabetes and Metabolic Diseases, University Children’s Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia; 3 Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia; 4 University Rehabilitation Institute, Ljubljana, Slovenia; 5 Faculty of Mathematics, Natural Sciences and Information Technologies, University of Primorska, Koper, Slovenia; 6 Department of Pediatric Surgery and Intensive Therapy, University Medical Centre Ljubljana, Ljubljana, Slovenia

BACKGROUND: The aim of this study was to determine how end-of-life decisions (EOLD) on limitations of life-sustaining treatment (LST) are made in three different types of intensive care units (ICUs) in Slovenia.
METHODS: A national multicenter prospective study among 31 adult and three pediatric/neonatal ICUs (PICUs). The questionnaire form on EOLD was designed to assess the clinical practice. Data were collected between January 1, 2013, and March 31, 2013. For statistical analysis we used IBM® SPSS® Statistics 20 software package.
RESULTS: Overall, of 4226 patients were admitted to ICUs, the EOLD on limitation of LST were performed in 112 patients (23.9%) out of 468 patients, which had died and/or had been subject to EOLD on limitation of LST. In 86.2% of the cases, patients had impaired competence. Advance directives were available only in 1.9% (2 out of 106 patients) of the cases. In the majority of cases, the EOLD was taken by the physicians (96.2%). In 61.8% of the cases, patient representatives were involved in the discussion about limitation of LST. The do-not-resuscitate order and withholding of inotropes/vasopressors were the most common measures to limit LST. Most commonly withdrawn were inotropes/vasopressors and antibiotics. Palliative care was included in 72.3% of the cases (80 out of 112 patients), however, palliative care team was only included in 4% of the cases.
CONCLUSIONS: No differences were found between the three different types of ICUs in EOLD on limitation of LST even though limitation of LST was provided regularly. The most commonly limited LST measures include mechanical ventilation, inotropes/vasopressors, hemodialysis, and antibiotics. Almost none of the patients had advance directives in place. Palliative care team was available in only few cases.

KEY WORDS: Intensive Care Unit - Resuscitation orders - Advance directives - Medical futility

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