TY - JOUR
T1 - Private attending physician status and the withdrawal of life-sustaining interventions in a medical intensive care unit population
AU - Kollef, Marin H.
PY - 1996/6
Y1 - 1996/6
N2 - Objective: To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within 8 medical intensive care unit (ICU). Design: Retrospective cohort analysis. Setting: An academic tertiary care center. Patients: One hundred fifty-nine consecutive patient deaths occurring in the medical ICU during a 12-month period. Interventions: None. Measurements and Main Results: Withdrawal of lite- sustaining interventions (i.e., mechanical ventilation, dialysis, and/or vasopressors), duration of mechanical ventilation, length of intensive care unit stay, medical care costs, and patient charges were recorded. Life-sustaining interventions were actively withdrawn from 69 (43.4%) patients prior to death. Patients without a private attending physician were significantly more likely to undergo the withdrawal of life-sustaining interventions compared with patients having a private attending physician (odds ratio = 2.5; 95% confidence interval = 1.8, 3.6, respectively; p = .005). A correlation was found between the possession of private health insurance and private attending physician status (r2 = .30, p < .001). Multiple logistic regression analysis was subsequently used to control for demographic factors and severity of illness. Three independent predictors for the withdrawal of life-sustaining interventions were identified in this patient cohort (p < .05): having a planned therapeutic trial of life-sustaining interventions outlined in the medical record (adjusted odds ratio = 9.4; 95% confidence interval = 5.6 to 15.6; p < .001); lack of a private attending physician (adjusted odds ratio = 4.4; 95% confidence interval = 2.9 to 6.5; p < .001); and the presence of clearly defined advance directives regarding patient preferences for medical care (adjusted odds ratio = 3.6; 95% confidence interval = 2.3 to 5.7; p = .005). Patients with private attending physicians had significantly greater medical care costs and medical care charges compared with patients without a private attending physician. Conclusion: Among patients dying within a medical ICU, those patients without a private attending physician are more likely to undergo the active withdrawal of life-sustaining interventions.
AB - Objective: To assess the influence of private attending physician status on the withdrawal of life-sustaining interventions among patients dying within 8 medical intensive care unit (ICU). Design: Retrospective cohort analysis. Setting: An academic tertiary care center. Patients: One hundred fifty-nine consecutive patient deaths occurring in the medical ICU during a 12-month period. Interventions: None. Measurements and Main Results: Withdrawal of lite- sustaining interventions (i.e., mechanical ventilation, dialysis, and/or vasopressors), duration of mechanical ventilation, length of intensive care unit stay, medical care costs, and patient charges were recorded. Life-sustaining interventions were actively withdrawn from 69 (43.4%) patients prior to death. Patients without a private attending physician were significantly more likely to undergo the withdrawal of life-sustaining interventions compared with patients having a private attending physician (odds ratio = 2.5; 95% confidence interval = 1.8, 3.6, respectively; p = .005). A correlation was found between the possession of private health insurance and private attending physician status (r2 = .30, p < .001). Multiple logistic regression analysis was subsequently used to control for demographic factors and severity of illness. Three independent predictors for the withdrawal of life-sustaining interventions were identified in this patient cohort (p < .05): having a planned therapeutic trial of life-sustaining interventions outlined in the medical record (adjusted odds ratio = 9.4; 95% confidence interval = 5.6 to 15.6; p < .001); lack of a private attending physician (adjusted odds ratio = 4.4; 95% confidence interval = 2.9 to 6.5; p < .001); and the presence of clearly defined advance directives regarding patient preferences for medical care (adjusted odds ratio = 3.6; 95% confidence interval = 2.3 to 5.7; p = .005). Patients with private attending physicians had significantly greater medical care costs and medical care charges compared with patients without a private attending physician. Conclusion: Among patients dying within a medical ICU, those patients without a private attending physician are more likely to undergo the active withdrawal of life-sustaining interventions.
KW - advance directives
KW - critical illness
KW - dialysis
KW - health insurance
KW - intensive care
KW - life support
KW - mechanical ventilation
KW - medical ethics
KW - vasopressors
UR - http://www.scopus.com/inward/record.url?scp=0029891006&partnerID=8YFLogxK
U2 - 10.1097/00003246-199606000-00016
DO - 10.1097/00003246-199606000-00016
M3 - Article
C2 - 8681600
AN - SCOPUS:0029891006
SN - 0090-3493
VL - 24
SP - 968
EP - 975
JO - Critical care medicine
JF - Critical care medicine
IS - 6
ER -