ICU sedation, delirium & recovery
Advance directives in the intensive care unit: An eight-year vanguard cohort study
Authors' conclusion
Advance directives are available in a minority of ICU patients and often contain subjective/contradictory wording. Physicians respected directives in 90 % of patients, with treatment adapted following their wishes.
Study context
- Population
- Patients with advance directives treated in a Swiss tertiary ICU ≥48 htreated ≥48 h in intensive care units (ICUs)
- Participants
- 5'851 patients
- Outcome
- Violation of advance directives
Methodological detailssingle-centre, tertiary ICU
- Single-centre
- Tertiary ICU
Main finding
As reported in the abstract
Violation of directives
- Directives violated
- 9%
- Worse in-hospital outcomes with directive violations
- p = 0.012
- Patients with violations unable to communicate at admission
- 64 %
- Directives missing/unrecognized in patients with violations
- 30 %
- Directives not followed: life-prolonging measures
- 6 %
- Directives not followed: ICU admission
- 5 %
- Directives not followed: mechanical ventilation
- 3 %
Observational data: associations, not effects.
Secondary outcomes
Prevalence and content of advance directives
%
- Patients with documented directives
- 2.7
- Directives using templates
- 92
- Subjective wording
- 19
- Contradictory wording
- 12
Survival (Kaplan Meier)
- Lower survival with directives recognized at admission
- P = 0.04
- Lower survival when treatment was withheld
- P < 0.001
Original publication
Advance directives in the intensive care unit: An eight-year vanguard cohort study. J Crit Care. Published 17 September 2024. doi:10.
Composed by AI from the published abstract and checked against it. How Briefs are made →