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1 Respiratory Intensive Care Unit, S. Maugeri Foundation, Scientific Institute of Pavia, Pavia, 2 Respiratory Intensive Care Unit, Poma Hospital, Mantua, 4 Statistician QBGROUP, Padua, and 6 Respiratory Intensive Care Unit, Careggi Hospital, Florence, Italy. 3 Respiratory Intensive Care Unit, Social Medical Centre, Vienna, Austria. 5 Respiratory Intensive Care Unit, Marius Nasta National Institute of Pneumology, Bucharest, Romania. 7 Academic Dept of Sleep and Breathing, Royal Brompton Hospital, London, UK.
CORRESPONDENCE: S. Nava, Respiratory Intensive Care Unit, Fondazione S.Maugeri, I.R.C.C.S., Istituto Scientifico di Pavia, Via Maugeri 10, 27100 Pavia, Italy. Fax: 39 382592075. E-mail: snava{at}fsm.it
Keywords: Chronic obstructive pulmonary disease, end-of-life decisions, end-stage respiratory diseases, ethics, noninvasive mechanical ventilation respiratory intermediate care unit, survey
Received: October 2, 2006
Accepted February 14, 2007
A survey was performed on behalf of the European Respiratory Society to assess end-of-life practices in patients admitted to European respiratory intermediate care units and high dependency units over a 6-month period.
A 33-item questionnaire was sent by e-mail to physicians throughout Europe and the response rate was 28 (29.5%) out of 95. A total of 6,008 patients were admitted and an end-of-life decision was taken in 1,292 (21.5%). The mortality rate in these patients was 68% (884 out of 1,292).
The patients received similar proportions of withholding of treatment (298 (23%) out of 1292), do-not-resuscitate or do-not-intubate orders (442 (34%) out of 1,292) and noninvasive mechanical ventilation as the ceiling of ventilatory care (402 (31%) out of 1,292). Withdrawal of therapy was employed in 149 (11%) out of 1,292 patients and euthanasia in one. Do-not-intubate/do-not-resuscitate orders were more frequently used in North compared with South Europe. All of the 473 competent patients directly participated in the decision, whereas, in 722 (56%) out of 1,292 cases, decision-making was reported to be shared with the nurses.
In European respiratory intermediate care units and high dependency units, an end-of-life decision is taken for 21.5% of patients admitted. Withholding of treatment, do-not-intubate/do-not-resuscitate orders and noninvasive mechanical ventilation as the ventilatory care ceiling are the most common procedures. Competent patients are often involved, together with nurses.
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