Analysis of management protocols regarding ineffective maintenance of organ functions in patients treated at the Intensive Care Unit of the University Hospital in Wroclaw

Background
Prolonged support of organ functions without therapeutic benefit represents a serious problem of therapy in intensive care units (ICUs). This kind of treatment, called “futile therapy”, prolongs the process of dying and should be avoided. In Poland, the guidelines and protocol defining the best clinical practice for the avoidance of futile therapy in ICUs was published in 2014. The aim of study was to analyse the protocols concerning futile therapy in the general ICU in the University Hospital in Wrocław, Poland during the years 2015–2018.

Methods
The content of protocols was analysed. The protocols contained information on clinical problems, ethical and social aspects, data on communication with relatives, and therapeutic procedures regarded as futile and consequently withheld or withdrawn.

Results
During the study 1660 patients were treated in the ICU, of whom 557 patients died. Protocols regarding futile therapy were analysed in 146 patients. The diagnosis before starting the protocol was multiorgan failure (56%), permanent CNS injury (39%), respiratory failure (3%), and circulatory failure (2%). The withholding of therapeutic procedures was preferred, and the cases of withdrawal were rare. All patients with protocols died during hospital stay, 81.5% of them in the ICU.

Conclusions
The protocols concerning futile therapy were instituted in 1 in 10 patients treated in the ICU in Wrocław, which comprised was nearly one-fifth of all ICU deaths. The withholding of futile therapeutic procedures was preferred in comparison to withdrawing. Communication with relatives was essential to the process of avoiding futile therapy.