Prevalence of Potentially Inappropriate Treatments (INAPPT-ICU)

Potentially Inappropriate Treatments in Turkish ICUs: Point Prevalence Study

A multicenter point prevalence study in Turkish intensive care units.

Study Overview

• Status: Completed
• Conditions: Critical Illness; Terminal Illness; Potentially Inappropriate Medication List

Detailed Description

Intensive care units (ICU) are life-saving units for critical patients with using advanced technology. In some cases, it becomes a unit where treatment is not possible, the fatal patients are admitted and the death process is extended. Most patients with end-stage cancer, advanced-stage chronic obstructive pulmonary disease (COPD) and advanced-stage Alzheimer's disease prefer to die at home, although many often refer to emergency services at the end of their life and are then transferred to the ICU. Intensive care treatments are often very invasive and painful interventions. The patient who lives in intensive care unit is faced with many psychological distresses such as communication, isolation and fear besides physical ache. For this reason, it is necessary to make decisions (end-of-life decisions) such as forbearing intensive care treatments applied to the patients in the death process or cutting out the ones started. In the world, the goal for the end of life patients is, improving the last phase of their lives with the application of these decisions and symptom therapy, living in a peace without pain and respiratory distress. However, there is an uncertanity in these issues in our country and intensive care physicians are hesitant to make decisions about the end of life with concern about legal problems. Although it is known that these patients will not benefit most from the treatment of ICU, they are getting treatments for saving their lives in ICUs. The fact that intensive care beds are not available due to the patients who are not get beneficial treatment, brings the result of difficult finding of the beds which will benefit from the intensive care, and in fact it is a waste of intensive care resources which is very expensive. The size of the problem is not known as there is no data on the frequency of patients in our country who are in intensive care and require end-of-life care.

In this multicenter point prevalence study our aims are;

• to find out the incidence of patients in intensive care units in Turkey in the last period of life,
• to compare the resource use of end-of-life and non-end-of-life patients.

• Study Type: Observational
• Enrollment (Actual): 1128

Contacts and Locations

Study Locations

• Turkey
  • Istanbul, Turkey
    • İstanbul University Cerrahpaşa Medical School

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: All

• Sampling Method: Non-Probability Sample

Study Population

All intensive care patients fulfilling eligibility criteria

Description

Inclusion Criteria:

All patients who are over 18 years old, more than 48 hours in the intensive care unit, or expected to be hospitalized

Exclusion Criteria:

Patients under 18 years of age, less than 48 hours in the intensive care unit stay, or who are monitorized for post-operative care

Study Plan

How is the study designed?

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Prevalence of terminal patients in the ICU	Investigation of the number of terminal patients treated in the intensive care units at the last days of life	1 day

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Resource use	Comparison of treatment implementations such as antibiotics, use of mechanical ventilation, renal replacement therapy, nutrition and blood transfusions and their estimated costs, used for terminal and non-terminal patients	1 day

Collaborators and Investigators

• Sponsor: Istanbul University

Publications and helpful links

General Publications

• Nelson JE, Bassett R, Boss RD, Brasel KJ, Campbell ML, Cortez TB, Curtis JR, Lustbader DR, Mulkerin C, Puntillo KA, Ray DE, Weissman DE; Improve Palliative Care in the Intensive Care Unit Project. Models for structuring a clinical initiative to enhance palliative care in the intensive care unit: a report from the IPAL-ICU Project (Improving Palliative Care in the ICU). Crit Care Med. 2010 Sep;38(9):1765-72. doi: 10.1097/CCM.0b013e3181e8ad23.
• Shreves A, Marcolini E. End of life/palliative care/ethics. Emerg Med Clin North Am. 2014 Nov;32(4):955-74. doi: 10.1016/j.emc.2014.07.010. Epub 2014 Sep 16.

Study record dates

Study Major Dates

• Study Start (Actual): October 15, 2018
• Primary Completion (Actual): November 14, 2018
• Study Completion (Actual): November 30, 2018

Study Registration Dates

• First Submitted: April 13, 2018
• First Submitted That Met QC Criteria: April 26, 2018
• First Posted (Actual): May 9, 2018

Study Record Updates

• Last Update Posted (Actual): March 1, 2019
• Last Update Submitted That Met QC Criteria: February 28, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Critical Illness
• Other Study ID Numbers: EERDOGAN

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No