End-of-life decisions in surgical intensive care medicine - the relevance of blood transfusions.
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 Surgical patients, who had blood transfusions withheld (44.6%), had more ICU-therapies withheld or withdrawn simultaneously than patients who had transfusions maintained (5 ± 2 vs. 2 ± 1, p 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.
['Graw|Jan A|JA|', 'Spies|Claudia D|CD|', 'Wernecke|Klaus-D|KD|', 'Braun|Jan-P|JP|']
D000368:Aged D000369:Aged, 80 and over D001803:Blood Transfusion D003657:Decision Making D006801:Humans D007362:Intensive Care Units D008020:Life Support Care D008875:Middle Aged D011795:Surveys and Questionnaires D013727:Terminal Care
End-of-life decision Intensive care medicine Blood transfusion Limitation order Surgical intensive care unit