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Vol. 44. Issue 2.
Pages 101-112 (March 2020)
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Vol. 44. Issue 2.
Pages 101-112 (March 2020)
Special article
DOI: 10.1016/j.medine.2019.07.003
Update and recommendations in decision making referred to limitation of advanced life support treatment
Puesta al día y recomendaciones en la toma de decisiones de limitación de tratamientos de soporte vital
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Á. Estellaa,
Corresponding author
litoestella@hotmail.com

Corresponding author.
, I. Saraleguib, O. Rubio Sanchizc, A. Hernández-Tejedord, V. López Campse, M.C. Martínf, L. Cabré Pericasg, N. Masnou Burrallóh, M. Recuerda Nuñezi, J.L. Monzónj
a Unidad de Cuidados Intensivos Hospital Universitario de Jerez, Cádiz, Spain
b Hospital de Áraba, Vitoria-Gasteiz, Araba, Spain
c Servicio de Cuidados Intensivos. Hospital Sant Joan de Déu. Fundació Althaia Xarxa Hospitalaria Universitaria de Manresa, Manresa, Barcelona, Spain
d Hospital Universitario Fundación Alcorcón, Alcorcón, Madrid, Spain
e UCI, Hospital de Sagunto, Sagunto, Valencia, Spain
f UCI, Hospital de Torrejón, Torrejón de Ardoz, Madrid, Spain
g Unidad de Cuidados Intensivos, Hospital de Barcelona SCIAS, Barcelona, Spain
h Hospital Universitari de Girona Dr. Josep Trueta, Girona, Spain
i Hospital Universitario de Puerto Real, Puerto Real, Cádiz, Spain
j Unidad de Cuidados Intensivos, Hospital de San Pedro, Logroño, La Rioja, Spain
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Figures (2)
Tables (6)
Table 1. Advantages of shared healthcare planning.
Table 2. Different types of limitation of life-support treatments.
Table 3. Fundamental aspects of palliative care at the ICU setting.
Table 4. Difficulties and solutions to integrate palliative care at the ICU setting.
Table 5. Procedure for shared end-of-life healthcare decisions at the ICU setting.
Table 6. SEMICYUC quality indicators associated with end-of-life care.
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Abstract

The Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) Bioethics Working Group has developed recommendations on the Limitation of Advanced Life Support Treatment (LLST) decisions, with the aim of reducing variability in clinical practice and of improving end of life care in critically ill patients.

The conceptual framework of LLST and futility are explained. Recommendations referred to new forms of LLST encompassing also the adequacy of other treatments and diagnostic methods are developed. In addition, planning of the possible clinical courses following the decision of LLST is commented. The importance of advanced care planning in decision-making is emphasized, and intensive care oriented towards organ donation at end of life in the critically ill patient is described. The integration of palliative care in the critical patient treatment is promoted in end of life stages in the Intensive Care Unit.

Keywords:
Limitation to advanced life support treatment
End of life
Bioethics
Resumen

El Grupo de Trabajo de Bioética de la SEMICYUC ha elaborado las recomendaciones en la toma de decisiones de limitación de tratamientos de soporte vital (LTSV) con la aspiración de disminuir la variabilidad en la práctica clínica observada y de contribuir a la mejora de los cuidados al final de la vida del paciente crítico. Además de abordar el marco conceptual de la LTSV y de la futilidad, desarrolla las nuevas formas de limitación extendiéndola a la adecuación de otros tratamientos y métodos diagnósticos, además de planificar los posibles cursos evolutivos tras la decisión de LTSV. Se enfatiza la importancia de la planificación compartida de la asistencia sanitaria en la toma de decisiones, se presentan los cuidados intensivos orientados a la donación y se promueve la integración de los cuidados paliativos en el tratamiento del paciente crítico en estadios del final de la vida en UCI.

Palabras claves:
Limitación de tratamientos de soporte vital
Final de la vida
Bioética

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