Factors related to limitation of life support within 48 h of intensive care unit admission: A multicenter study

Abstract Objective To determine factors related to limitations on life support within 48 h of intensive care unit (ICU) admission. Study design Prospective multicenter study. Setting Eleven ICUs. Patients All patients who died and/or had limitations on life support after ICU admission during a four-month period. Variables Patient characteristics, hospital characteristics, characteristics of limitations on life support. Time-to-first-limitation was classified as early ( Results 3335 patients were admitted; 326 (9.8%) had limitations on life support. A total of 344 patients died; 247 (71.8%) had limitations on life support (range among centers, 58.6%–84.2%). The median (p25–p75) time from admission to initial limitation was 2 (0–7) days. CHAID analysis found that the modified Rankin score was the variable most closely related with early limitations. Among patients with Rankin >2, early limitations were implemented in 71.7% (OR = 2.5; 95% CI: 1.5–4.4) and lung disease was the variable most strongly associated with early limitations (OR = 12.29; 95% CI: 1.63–255.91). Among patients with Rankin ≤2, 48.8% had early limitations; patients admitted after emergency surgery had the highest rate of early limitations (66.7%; OR = 2.4; 95% CI: 1.1–5.5). Conclusion Limitations on life support are common, but the practice varies. Quality of life has the greatest impact on decisions to limit life support within 48 h of admission.