Introduction:The need for end-of-life care is common in intensive care units (ICUs).Although guidelines exist, little is known about actual endof-life care practices in Hong Kong ICUs.The study aim was to provide a detailed description of these practices. Methods:This prospective, multicentre observational sub-analysis of the Ethicus-2 study explored end-of-life practices in eight participating Hong Kong ICUs.Consecutive adult ICU patients admitted during a 6-month period with lifesustaining treatment (LST) limitation or death were included.Follow-up continued until death or 2 months from the initial decision to limit LST.Results: Of 4922 screened patients, 548 (11.1%) had LST limitation (withholding or withdrawal) or died (failed cardiopulmonary resuscitation/brain death).Life-sustaining treatment limitation occurred in 455 (83.0%) patients: 353 (77.6%) had decisions to withhold LST and 102 (22.4%) had decisions to withdraw LST.Of those who died without LST limitation, 80 (86.0%) had failed cardiopulmonary resuscitation and 13 (14.0%)were declared brain dead.Discussions of LST limitation were initiated by ICU physicians in most (86.2%)cases.Shared decision-making between ICU physicians and families was the predominant model; only 6.0% of patients retained decision-making capacity.Primary medical reasons for LST limitation were unresponsiveness to maximal therapy (49.2%) and multiorgan failure (17.1%).The most important consideration for decision-making was the patient's best interest (81.5%).
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Joynt et al. (2024) studied this question.