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Vol. 218. Num. 1.January - February 2018
Pages 1-48
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Vol. 218. Num. 1.January - February 2018
Pages 1-48
Original article
DOI: 10.1016/j.rceng.2017.10.004
Limitation of therapeutic effort in patients hospitalized in departments of internal medicine
Limitación del esfuerzo terapéutico en pacientes hospitalizados en servicios de medicina interna
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R. García Caballeroa,b,c,
Corresponding author
rebecagarciacaballero@gmail.com

Corresponding author.
, B. Herrerosa,b,c, D. Real de Asúaa,c,d, S. Gámeze, G. Vegaf, L. García Olmosg
a Grupo de Trabajo de Bioética de la Sociedad Española de Medicina Interna, Madrid, Spain
b Unidad de Medicina Interna, Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
c Instituto de Ética Clínica Francisco Vallés, Universidad Europea, Madrid, Spain
d Servicio de Medicina Interna, Hospital Universitario de La Princesa, Madrid, Spain
e Hospital Universitario Infanta Cristina, Parla, Madrid, Spain
f Hospital Universitario Quironsalud, Pozuelo de Alarcón, Madrid, Spain
g Unidad docente multiprofesional de Atención Familiar y Comunitaria, Sureste, Madrid, Spain
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Tables (4)
Table 1. Baseline characteristics of the 382 patients who died.
Table 2. Causes of hospitalization and death of the included patients.
Table 3. Established limitation of therapeutic effort orders.
Table 4. Associations between limitation of therapeutic effort measures and patient characteristics.
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Abstract
Introduction

There is little information on the limitation of therapeutic effort (LTE) in patients admitted to hospital internal medicine units.

Objectives

To describe the indicated LTE regimens in the departments of internal medicine and the characteristics of the patients who undergo them.

Patients and methods

An observational, descriptive retrospective study was conducted on 4 hospitals of the Community of Madrid. The study collected demographic and comorbidity data and the LTE orders prescribed for all patients who died during a period of 6 months.

Results

The study included 382 patients with a mean age of 85±10 years; 204 were women (53.4%) and 222 (58.1%) came from their homes. Some 51.1% of the patients were terminal, 43.2% had moderate to severe dementia, and 95.5% presented at least moderate comorbidity. Some type of LTE was performed in 318 patients (83.7%); the most common orders were “No cardiopulmonary resuscitation” (292 patients, 76.4%; 95% CI 72.1–80.8), “Do not use aggressive measures” (113 patients, 16.4%; 95% CI 13.7–19.4) and “Do not transfer to an intensive care unit” (102 cases, 14.8%; 95% CI 12.3–17.7). Some type of LTE was performed in 318 patients (83.7%); the most common orders were “No cardiopulmonary resuscitation” (292 patients, 76.4%; 95% CI 72.1–80.8), “Do not use aggressive measures” (113 patients, 16.4%; 95% CI 13.7–19.4) and “Do not transfer to an intensive care unit” (102 cases, 14.8%; 95% CI 12.3–17.7).

Conclusions

LTE is common among patients who die in Internal Medicine. The most widely used regimens were “No CPR” and the unspecific statement “Do not use aggressive measures”. The patients were elderly and had significant comorbidity, terminal illness and advanced dementia.

Keywords:
Limitation of therapeutic effort
No cardiopulmonary resuscitation
Decision making
Internal medicine
Resumen
Introducción

Existe escasa información sobre la limitación del esfuerzo terapéutico (LET) en pacientes ingresados en unidades de hospitalización de medicina interna.

Objetivos

Describir las pautas de LET indicadas en los servicios de medicina interna y las características de los pacientes que las reciben.

Pacientes y métodos

Estudio observacional descriptivo y retrospectivo de 4 hospitales de la Comunidad de Madrid. Se recogieron datos demográficos, de comorbilidad y las órdenes de LET pautadas en todos los pacientes fallecidos en un periodo de 6 meses.

Resultados

Se incluyeron 382 pacientes cuya edad media fue de 85±10 años; 204 eran mujeres (53,4%) y 222 (58,1%) procedían de su domicilio. El 51,1% eran enfermos terminales, el 43,2% tenían demencia moderada/grave y el 95,5% presentaban comorbilidad al menos moderada. En 318 pacientes (83,7%) se realizó algún tipo de LET, siendo las más frecuentes las órdenes de «no reanimación cardiopulmonar» (292 enfermos, 76,4%; IC 95%: 72,1-80,8), «no usar medidas agresivas» (113 pacientes, 16,4%; IC 95%: 13,7-19,4) y «no ingresar en unidad de cuidados intensivos» (102 casos, 14,8%; IC 95%: 12,3-17,7).

Conclusiones

La LET es muy frecuente en los pacientes que fallecen en medicina interna. Las pautas más utilizadas son «no reanimación cardiopulmonar» y la expresión poco concreta de «no usar medidas agresivas». Los pacientes son de edad avanzada, con importante comorbilidad, enfermedad terminal y demencia avanzada.

Palabras clave:
Limitación del esfuerzo terapéutico
Órdenes de no reanimación cardiopulmonar
Toma de decisiones
Medicina interna

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