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Limitation of life sustaining treatments. a Unpaired analysis. b Matched paired analysis

Limitation of life sustaining treatments. a Unpaired analysis. b Matched paired analysis

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Purpose: The number of patients ≥ 80 years admitted into critical care is increasing. Coronavirus disease 2019 (COVID-19) added another challenge for clinical decisions for both admission and limitation of life-sustaining treatments (LLST). We aimed to compare the characteristics and mortality of very old critically ill patients with or without CO...

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Context 1
... survival was lower among COVID patients (Table 2) (Fig. 1a). At 1 month, survival was only 38% in COVID patients compared with 57% in non-COVID patients. Decisions to limit LST were more frequent among COVID patients (Table 2) (Fig. 2a). The time between ICU admission and withholding of LST was similar in both cohorts, whereas the time between admission and withdrawing was significantly longer in the COVID ...
Context 2
... was applied very differently: withholding was applied in 51.1% vs 25.9% and withdrawing 25.9% vs 14.1% in COVID and non-COVID patients, respectively (Table 4). The cumulative incidence of limitation (withholding or withdrawing) 7 days after ICU admission was 43% in COVID patients and 24% in non-COVID patients (Fig. ...

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Background: Providing palliative care at the end of life (EOL) in intensive care units (ICUs) seems to be modified during the COVID-19 pandemic with potential burden of moral distress to health care providers (HCPs). We seek to assess the practice of EOL care during the COVID-19 pandemic in ICUs in the Czech Republic focusing on the level of moral distress and its possible modifiable factors. Methods: Between 16 June 2021 and 16 September 2021, a national, cross-sectional study in intensive care units (ICUs) in Czech Republic was performed. All physicians and nurses working in ICUs during the COVID-19 pandemic were included in the study. For questionnaire development ACADEMY and CHERRIES guide and checklist were used. A multivariate logistic regression model was used to analyse possible modifiable factors of moral distress. Results: In total, 313 HCPs (14.5% out of all HCPs who opened the questionnaire) fully completed the survey. Results showed that 51.8% (n = 162) of respondents were exposed to moral distress during the COVID-19 pandemic. 63.1% (n = 113) of nurses and 71.6% of (n = 96) physicians had experience with the perception of inappropriate care. If inappropriate care was perceived, a higher chance for the occurrence of moral distress for HCPs (OR, 1.854; CI, 1.057-3.252; p = 0.0312) was found. When patients died with dignity, the chance for moral distress was lower (OR, 0.235; CI, 0.128-0.430; p < 0.001). The three most often reported differences in palliative care practice during pandemic were health system congestion, personnel factors, and characteristics of COVID-19 infection. Conclusions: HCPs working at ICUs experienced significant moral distress during the COVID-19 pandemic in the Czech Republic. The major sources were perceiving inappropriate care and dying of patients without dignity. Improvement of the decision-making process and communication at the end of life could lead to a better ethical and safety climate. Trial registration: NCT04910243 .