End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial.
Methods:
We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process.
Results:
In all, 745 participants, 10.01% of all admitted patients, were analyzed. Of them, 225 patients were RV group, and the remaining 520 were NRV group. Age and gender were comparable in the 2 groups. The use of vasopressors was associated with an admission diagnosis of sepsis and absence of Do-Not-Resuscitate consent and parenteral use of morphine. In multivariable analysis, a high Barthel index score, the absence of cancer and cardiopulmonary resuscitation (CPR), and no receipt of vasopressors were independent factors for LOS. For the length of the actively dying process, a longer duration of inotropic agent, the receipt of vasopressors, and the absence of CPR were independent factors.
Conclusion:
In-hospital mortality is not uncommon during hospitalization in a general ward. The length of the actively dying process is extended by the use of vasopressors. Further prospective study is required for cautious evaluation of the pros and cons of using vasopressors at the end of life during hospitalization.
Ling WangY-MLSe-ChenFanWei-TzuChao. Analysis of population projections for Taiwan area: 2008 to 2056 Taiwan economic forum. 2009;7(8):36–69.
2.
DroninaYYoonYMSakamakiHNamEW. Health system development and performance in Korea and Japan: a comparative study of 2000-2013. J Lifestyle Med. 2016;6(1):16–26.
3.
HeWanGoodkindDanielKowalPaul. An Aging World: 2015. 2016. Washington DC: U.S. Government Publishing Office.
4.
ChihAHSuPHuWY. The changes of ethical dilemmas in palliative care. a lesson learned from comparison between 1998 and 2013 in Taiwan. Medicine (Baltimore). 2016;95(1):e2323.
5.
ChanCWChuiYYChairSY. The evaluation of a palliative care programme for people suffering from life-limiting diseases. J Clin Nurs. 2014;23(1-2):113–123.
ChengMTHsihFYTsaiCLTsaiHBTsaiDFFangCC. Increased rate of DNR status in hospitalized end-of-life patients in Taiwan. Intensive Care Med. 2016;42(11):1816–1817.
8.
GoldfingerJZAdlerED. End-of-life options for patients with advanced heart failure. Curr Heart Fail Rep. 2010;7(3):140–147.
9.
O’MahonySMcHenryJBlankAE. Preliminary report of the integration of a palliative care team into an intensive care unit. Palliat Med. 2010;24(2):154–165.
10.
BaekSKChangHJByunJMHanJJHeoDS. The association between end-of-life care and the time interval between provision of a do-not-resuscitate consent and death in cancer patients in Korea. Cancer Res Treat. 2017;49(2):502–508.
11.
DellingerRPLevyMMRhodesA. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock, 2012. Intensive Care Med. 2013;39(2):165–228.
12.
HuangYCHuangSJKoWJ. Going home to die from surgical intensive care units. Intensive Care Med. 2009;35(5):810–815.
13.
LeAPatelS. Extravasation of noncytotoxic drugs: a review of the literature. Ann Pharmacother. 2014;48(7):870–886.
14.
HayesMAYauEHHindsCJWatsonJD. Symmetrical peripheral gangrene: association with noradrenaline administration. Intensive Care Med. 1992;18(7):433–436.
15.
AvniTLadorALevSLeiboviciLPaulMGrossmanA. Vasopressors for the treatment of septic shock: systematic review and meta-analysis. PLoS One. 2015;10(8):e0129305.
16.
DuesingLAFawleyJAWagnerAJ. Central venous access in the pediatric population with emphasis on complications and prevention strategies. Nutr Clin Pract. 2016;31(4):490–501.
17.
World Medical A. World Medical Association Declaration Of Helsinki. Ethical principles for medical research involving human subjects. Bull World Health Organ. 2001;79(4):373–374.
18.
WangHYChewGKungCTChungKJLeeWH. The use of Charlson comorbidity index for patients revisiting the emergency department within 72 hours. Chang Gung Med J. 2007;30(5):437–444.
19.
SainsburyASeebassGBansalAYoungJB. Reliability of the Barthel index when used with older people. Age Ageing. 2005;34(3):228–232.
20.
MurraySBBatesDWNgoLUfbergJWShapiroNI. Charlson index is associated with one-year mortality in emergency department patients with suspected infection. Acad Emerg Med. 2006;13(5):530–536.
21.
WeissmanD. Policy proposal: do not resuscitate orders: a call for reform. Virtual Mentor. 2003;5(1). doi:10.1001/virtualmentor.2003.5.1.pfor2-0301.
22.
HwangICAhnHYParkSMShimJYKimKK. Clinical changes in terminally ill cancer patients and death within 48 h: when should we refer patients to a separate room?Support Care Cancer. 2013;21(3):835–840.
23.
NguyenATTsaiCLHwangLYLaiDMarkhamCPatelB. Obesity and mortality, length of stay and hospital cost among patients with sepsis: a nationwide inpatient retrospective cohort study. PLoS One. 2016;11(4):e0154599.
24.
PalmerWWYuenFK. The impact of hospice patient disease type and length of stay on caregiver utilization of grief counseling. Am J Hosp Palliat Care. 2017;34(9):880–886.
25.
AnARLeeJKYunYHHeoDS. Terminal cancer patients’ and their primary caregivers’ attitudes toward hospice/palliative care and their effects on actual utilization: a prospective cohort study. Palliat Med. 2014;28(7):976–985.
26.
KonAAShepardEKSederstromNO. Defining futile and potentially inappropriate interventions: a policy statement from the society of Critical Care Medicine Ethics Committee. Crit Care Med. 2016;44(9):1769–1774.
27.
TreschDDThakurRK. Cardiopulmonary resuscitation in the elderly. beneficial or an exercise in futility?Emerg Med Clin North Am. 1998;16(3):649–663.
28.
OualhaMCapeloMSpreux-VaroquauxO. Delay and stability of central venous administration of norepinephrine in children: a bench study. Eur J Pediatr. 2014;173(1):69–73.
29.
von GuntenCF. Promoting palliative care. Acad Med. 2015;90(12):1585.
30.
BekelmanJEHalpernSDBlankartCR. Comparison of site of death, health care utilization, and hospital expenditures for patients dying with cancer in 7 developed countries. JAMA. 2016;315(3):272–283.
31.
RockerGDownarJMorrisonRS. Palliative care for chronic illness: driving change. CMAJ. 2016;188(17-18):E493–E498.
32.
MounceyPROsbornTMPowerGS. Trial of early, goal-directed resuscitation for septic shock. N Engl J Med. 2015;372(14):1301–1311.
33.
LemanPMorleyP. Review article: updated resuscitation guidelines for 2016: A summary of the Australian and New Zealand committee on resuscitation recommendations. Emerg Med Australas. 2016;28(4):379–382.
34.
RaithEPUdyAABaileyM. Prognostic accuracy of the sofa score, sirs criteria, and qsofa score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit. JAMA. 2017;317(3):290–300.
35.
FinkelsteinEMalhotraCChayJOzdemirSChopraAKanesvaranR. Impact of treatment subsidies and cash payouts on treatment choices at the end of life. Value Health. 2016;19(6):788–794.
36.
WangCLDingSTHsiehMJ. Factors associated with emergency department visit within 30 days after discharge. BMC Health Serv Res. 2016;16:190.
37.
LowLLLiuNWangSThumbooJOngMELeeKH. Predicting 30-day readmissions in an Asian population: building a predictive model by incorporating markers of hospitalization severity. PLoS One. 2016;11(12):e0167413.
38.
MortazETabarsiPMansouriD. Cancers related to immunodeficiencies: update and perspectives. Front Immunol. 2016;7:365.
39.
UppalDSWangAY. Advances in endoscopic retrograde cholangiopancreatography for the treatment of cholangiocarcinoma. World J Gastrointest Endosc. 2015;7(7):675–687.
40.
van GijnMSFrijnsDvan de GlindEMvan MunsterB CHamakerME. The chance of survival and the functional outcome after in-hospital cardiopulmonary resuscitation in older people: a systematic review. Age Ageing. 2014;43(4):456–463.
41.
Bro-JeppesenJAnnbornMHassagerC. Hemodynamics and vasopressor support during targeted temperature management at 33 degrees C Versus 36 degrees C after out-of-hospital cardiac arrest: a post hoc study of the target temperature management trial*. Crit Care Med. 2015;43(2):318–327.
