Medical Ethic Research:The Current Situation And Reasons Of Implementing Withholding/Withdrawal Life Support Treatment

Objective:Investigate present situation of withholding life support treatment (WH-LST) and withdrawal life support treatment (WD-LST) implementation in the intensive care unit (ICU). Generalize the influencing factors of implementing WH/WD-LST in some areas of Kunming, China.Methods:A single center prospective clinical study. Collect the patients who treated by Emergency Intensive Care Unit (EICU) of the first affiliated hospital of Kunming Medical University and implement WH/WD-LST finally from July 2015 to December 2015. Collect their demographic information; ICU diagnosis; disease severity; WH/WD-LST implementing content, reasons and ICU cost. Use the acute physiology and chronic health evaluation II (APACHE II) and Simplified Acute Physiology Score II (SAPS II) to mark the disease severity. Classify patients:(1) by the proposer of implementing withhold (WH)/withdraw (WD) into three groups:Doctor Group, Patient’s Family Group and Patient Group; (2) or by the contents of withhold (WH)/withdraw (WD) into three groups:WH Only Group, WD Only Group and WH&WD Group. Compare data during groups or with routine therapy (RT) patients in the same period. Use Binary logistic regression to analysis the connection between influencing factors and WH/WD-LST.Results:During study period,72 of EICU patients implement WH/WD-LST (16.9%).38 of them are male (52.8%, vs RT 51.2%, P=0.917). The age of WH/WD patients is higher by (75.2±10.6) [vs RT (62.6±12.5), P=0.008]. And with age, the rate of WH/WD implementation increases. The total mortality of WH/WD patients is 88.9% (vs RT 10.5%, P=0.021), WD Only patients are the worst by 92.3%(vs RT 10.5%, P=0.001). Admitting acute diagnosis of WH/WD patients are locating disease cause (45.8%), pneumonia (38.9%), pancreatitis (33.3%) and cranial trauma (23.6%), comparing with RT patients do not exist statistical significance. But, the final acute diagnosis are different:Coma (88.9%), acid-base/electrolyte disturbance (72.2%), multiple organ dysfunction syndrome (MODS) (63.9%) and Sepsis/Septic Shock (50.0%) are common among WH/WD patients, comparing with RT patients exist statistical significance. The total cost of WH/WD patients are lower by 63 (9,148) thousand yuan [vs RT 161 (17,325) thousand yuan, P=0.005], but the predict ICU cost are higher by 200 (150,450) thousand yuan [vs RT 150 (100,200) thousand yuan, P=0.036]. The final APACHE II score and SAPS Ⅱ score of WH/WD patients are both higher:28.0 (23.0,31.0) [vs RT 8.0 (5.0,10.0), P=0.002] and 64.0 (44.0,82.0) [vs RT 15.0 (7.0,18.0), P=0.001]. During the study,24 of 72 WH/WD patients are suggested by doctors (33.3%). And the most common participators of WH/WD-LST symposiums are ICU advanced doctors, doctors in charge and relatives. The main WH/WD-LST content is WH rescue measures, especially WH the temporary pacemaker implantation (94.4%) and WH defibrillation (90.3%). The main reason of implementing WH/WD-LST:from relatives are "believing physical and psychological pain are great, hope to relieve them", "age" and "total ICU cost"; but from doctors are "low treatment effect" and "poor existent prospective". Binary logistic regression analysis shows:patient’s age, △APACHE II score, △SAPS II score, ICU prospective cost are the relative influencing factors to implementing WH/WD-LST.Conclusion:1. The proportion of implementing WH/WD-LST in some areas of Kunming is really high, and most implementions are suggested by relatives; 2. Mental, age and economy are the main factors for relatives to implement WH/WD-LST, but for doctors, value evaluation of severity is the main one; 3. Patient’s age, △APACHE II score, △SAPS II score and predict ICU cost are the four factors of implementing WH/WD-LST by now.