Limitation of life-sustaining treatments in Asian ICUs: theory versus practice

IF 8.8 1区医学 Q1 CRITICAL CARE MEDICINE Critical Care Pub Date : 2025-01-06 DOI:10.1186/s13054-024-05241-2

Lowell Ling, Andrew Li, Jason Phua

{"title":"Limitation of life-sustaining treatments in Asian ICUs: theory versus practice","authors":"Lowell Ling, Andrew Li, Jason Phua","doi":"10.1186/s13054-024-05241-2","DOIUrl":null,"url":null,"abstract":"<p>We thank Wang and Zhong for raising the important considerations on limitation or withdrawal of therapy in the MOSAICS II studies [1]. Although limitation or withdrawal of therapy was not part of the exclusion criteria for MOSACIS II, data on subsequent limitation of therapy or withdrawal of therapy during ICU stay was collected but not previously published [2, 3]. Amongst the 4826 patients included in the MOSACIS II secondary analysis on qSOFA prognostic value, only 5.9% (283/4826) had withdrawal of life-sustaining treatments and 5.9% (287/4826) had withholding of life-sustaining treatments [3]. Even amongst those who died within 28 days, only 11.2% (142/1271) and 10.8% (137/1271) had withdrawal or withholding of life-sustaining treatments prior to death. Overall, low rates of limitation of therapy suggest it may not have significantly biased the conclusions drawn about prognostic value of qSOFA in sepsis.</p><p>The Asian Critical Care Clinical Trials group have previously published multiple survey studies on end-of-life practices in Asian ICUs [4,5,6]. However, real-life observations on end-of-life practices in MOSAICS II seem discrepant to these survey results. The ACME study reported that 70.2% of Asian ICU physicians would almost always or often withhold life-sustaining treatments and 20.7% would withdraw such treatments for patients with no real chance of recovering meaningful life [4]. The low observed rates of limitation of therapy in MOSAICS II may reflect the perception that limitation of life-sustaining treatment may expose the physician to legal risks [5]. Furthermore, there is significant variations in practice across cultures and income settings. As Wang and Zhong highlighted, Chinese physicians are more likely to consider financial burden when considering limiting life-sustaining treatments [6].</p><p>We appreciate the suggestions made by Wang and Zhong and agree that variations in local end-of-life practices may impact clinical research and care of critically ill patients in Asian ICUs. More prospective data are needed to understand the cultural and religious, financial and contextual factors that shape end-of-life practices in ICUs.</p><p>The data that support the findings of this study are available from the corresponding author upon reasonable request.</p><ol data-track-component=\"outbound reference\" data-track-context=\"references section\"><li data-counter=\"1.\"><p>Wang M, Zhong L. Reflections on epidemiological investigations of sepsis in the Asian Region. Crit Care. 2024;28(1):59.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"2.\"><p>Li A, Ling L, Qin H, Arabi YM, Myatra SN, Egi M, et al. Epidemiology, management, and outcomes of sepsis in ICUs among countries of differing national wealth across Asia. Am J Respir Crit Care Med. 2022;206(9):1107–16.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"3.\"><p>Li A, Ling L, Qin H, Arabi YM, Myatra SN, Egi M, et al. Prognostic evaluation of quick sequential organ failure assessment score in ICU patients with sepsis across different income settings. Crit Care. 2024;28(1):30.</p><p>Article PubMed PubMed Central Google Scholar </p></li><li data-counter=\"4.\"><p>Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in intensive care units in Asia. JAMA Intern Med. 2015;175(3):363–71.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"5.\"><p>Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN, Chan YH, et al. Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions. Intensive Care Med. 2016;42(7):1118–27.</p><p>Article PubMed Google Scholar </p></li><li data-counter=\"6.\"><p>Park SY, Phua J, Nishimura M, Deng Y, Kang Y, Tada K, et al. End-of-life care in ICUs in East Asia: a comparison among China, Korea, and Japan. Crit Care Med. 2018;46(7):1114–24.</p><p>Article CAS PubMed Google Scholar </p></li></ol><p>Download references<svg aria-hidden=\"true\" focusable=\"false\" height=\"16\" role=\"img\" width=\"16\"><use xlink:href=\"#icon-eds-i-download-medium\" xmlns:xlink=\"http://www.w3.org/1999/xlink\"></use></svg></p><p>MOSAICS II Study Group: The study sites and investigators who contributed to recruitment and data collection are listed in Additional file 1.</p><p>This was not a funded study.</p><h3>Authors and Affiliations</h3><ol><li><p>Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China</p><p>Lowell Ling</p></li><li><p>Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore</p><p>Andrew Li & Jason Phua</p></li><li><p>FAST and Chronic Programmed, Alexandra Hospital, National University Health System, Singapore, Singapore</p><p>Jason Phua</p></li></ol><span>Authors</span><ol><li><span>Lowell Ling</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Andrew Li</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li><li><span>Jason Phua</span>View author publications<p>You can also search for this author in <span>PubMed<span> </span>Google Scholar</span></p></li></ol><h3>Consortia</h3><h3>the MOSAICS II Study Group</h3><ul><li>Uzzal Kumar Mallick</li><li>, Motiul Islam</li><li>, Tarequl Hamid</li><li>, A. K. M. Shirazul Islam</li><li>, Rabiul Halim</li><li>, Md Arifur Rahman Khan</li><li>, Mohammad Asaduzzaman</li><li>, Md Rezaul Karim</li><li>, Nahim Sarwar</li><li>, Shamsul Hoque Milon</li><li>, Rashed Mahmud</li><li>, A. K. M. Sirajul Islam Hirok</li><li>, Ashraful Haque</li><li>, Amina Sultana</li><li>, Mir Atiqur Rahman Shajal</li><li>, Farha Andalib</li><li>, Rashedul Hasan</li><li>, Khalid Mahmood Khan Nafees</li><li>, Shah Sudhirchandra Dhansukhlal</li><li>, Ning Li</li><li>, Xiaowei Liu</li><li>, Haiwei Yang</li><li>, Ming Hou</li><li>, Ying Li</li><li>, Jian Zhang</li><li>, Lifeng Huang</li><li>, Wenxiong Li</li><li>, Meili Duan</li><li>, Taotao Liu</li><li>, Wei He</li><li>, Fangyu Ning</li><li>, Xiaozhi Wang</li><li>, Xiaoyan Zhou</li><li>, Sun Yu</li><li>, Xiang Xiang</li><li>, Liang Pan</li><li>, Feihu Zhou</li><li>, Yaoli Wang</li><li>, Jian Zhou</li><li>, Tao Wang</li><li>, Xuefei Yang</li><li>, Yu Ma</li><li>, Xuan Song</li><li>, Haiying Wu</li><li>, Chuanyun Qian</li><li>, Lixin Zhou</li><li>, Zuohang Xu</li><li>, Kun Zhang</li><li>, Zhenjie Hu</li><li>, Xingsheng Lin</li><li>, Songjing Shi</li><li>, Xiaoguang Zhang</li><li>, Rongguo Yu</li><li>, Liqin Zhang</li><li>, Yuan Yuan</li><li>, Huiru Zhou</li><li>, Xiandong Wang</li><li>, Zhonghua Wang</li><li>, Tiehe Qin</li><li>, Xianqing Shi</li><li>, Rui Li</li><li>, Zhenyang He</li><li>, Xiangrong Zuo</li><li>, Quan Cao</li><li>, Tao He</li><li>, Yuanda Sui</li><li>, Tiejun Wu</li><li>, Ying Xu</li><li>, Qin Gu</li><li>, Weizheng Shuai</li><li>, Hanyu Qin</li><li>, Bin Du</li><li>, Hong Qiao</li><li>, Shuangling Li</li><li>, Guiying Dong</li><li>, Xiujuan Zhao</li><li>, Fengxue Zhu</li><li>, Junshi Wang</li><li>, Lei Huang</li><li>, Tianchang Wang</li><li>, Hao Wang</li><li>, Siqing Ma</li><li>, Zhengping Yang</li><li>, Yuan Gao</li><li>, Ruoming Tan</li><li>, Yun Xie</li><li>, Ruilan Wang</li><li>, Jia Jia</li><li>, Bin Zang</li><li>, Jun Wang</li><li>, Ling Lin</li><li>, Yuwen Wu</li><li>, Yunfu Wu</li><li>, Penglin Ma</li><li>, Yanfang Li</li><li>, Li Yu</li><li>, Rui Guo</li><li>, Jiuzhi Zhang</li><li>, Xianyao Wan</li><li>, Feng Shen</li><li>, Qindong Shi</li><li>, Jun Xu</li><li>, Qiang Fang</li><li>, Shaohua Liu</li><li>, Tongwen Sun</li><li>, Mian Zeng</li><li>, Weiyun Pan</li><li>, Zhongmin Liu</li><li>, Qingling Lin</li><li>, Nan Wang</li><li>, Jing Pang</li><li>, Bin Xiong</li><li>, Deliang Wen</li><li>, Fuxin Kang</li><li>, Liuhui Chang</li><li>, Yun Sun</li><li>, Jingxiao Zhang</li><li>, Yongjie Yin</li><li>, Liu Qing</li><li>, Jiajun Sun</li><li>, Nahui Li</li><li>, Yongqiang Wang</li><li>, Songtao Shou</li><li>, Yanfen Chai</li><li>, Lei Xu</li><li>, Xiaobo Yang</li><li>, Xuelian Liao</li><li>, Xian Kang</li><li>, Shuangping Zhao</li><li>, Liquan Huang</li><li>, Run Zhang</li><li>, Renhua Sun</li><li>, Chao Shen</li><li>, Yan He</li><li>, Fu Loi Chow</li><li>, Michele Tang</li><li>, Philip Lam</li><li>, Esther Cham</li><li>, Kin Bong Tang</li><li>, Lowell Ling</li><li>, Manimala Dharmangadan</li><li>, Pauline Yeung Ng</li><li>, Kin Ho Ling</li><li>, Vincent Lau</li><li>, Samir Sahu</li><li>, Sharmila Chatterjee</li><li>, Sushmita Basu</li><li>, Zubair Umer Mohamed</li><li>, Sudeep Sirga</li><li>, Siddhartha Reddy Kasireddy</li><li>, M. A. Aleem</li><li>, Swarna Deepak Kuragayala</li><li>, Sai Praveen Haranath</li><li>, Nagarajan Ramakrishnan</li><li>, Pravin Amin</li><li>, Joanne Mascarenhas</li><li>, Radhika Dash</li><li>, Venkat Raman Kola</li><li>, R. Vaidyanathan</li><li>, Siddharth Agarwal</li><li>, Pradip K. Bhattacharya</li><li>, Deepak Jeswani</li><li>, Parshotum Lal Gautam</li><li>, Abdul Samad Ansari</li><li>, Vivek Nangia</li><li>, Mrinal Sircar</li><li>, V. M. Balasubramani</li><li>, S. Maneendra</li><li>, Sanghamitra Mishra</li><li>, Anjeev Kumar</li><li>, Rajesh Chawla</li><li>, Trevor Francis Sequeira</li><li>, Om Prakash Shrivastava</li><li>, T. V. Sreevalsan</li><li>, Rajesh Mohan Shetty</li><li>, Manjunath Thimmappa</li><li>, M. M. Harish</li><li>, Yatin Mehta</li><li>, Divya Saxena</li><li>, Vipul Mishra</li><li>, Rishi Kumar</li><li>, Simnt Kumar Jha</li><li>, Prashant Sakhavalkar</li><li>, Dnyaneshwar Diwane</li><li>, Subhal Dixit</li><li>, Kalaiselvan</li><li>, Manoranjan Pattnaik</li><li>, Lalit Singh</li><li>, Fareed Khan</li><li>, Mehul Shah</li><li>, Prasanna</li><li>, Ziokov Joshi</li><li>, Sheila Ninan Myatra</li><li>, Manoj Gorade</li><li>, Bharat G. Jagiasi</li><li>, Amol Hartalkar</li><li>, B. Saroj Kumar Prusty</li><li>, Yogesh</li><li>, Ade Winata</li><li>, Maulydia</li><li>, Surya Oto Wijaya</li><li>, Hermin Prihartini</li><li>, Shinta V. R. Hutajulu</li><li>, Rudy Manalu</li><li>, Christrijogo Sumartono</li><li>, Chrisma Adryana Albandjar</li><li>, Ira Pitaloka</li><li>, Dewi Kusumawati</li><li>, Arifin</li><li>, Akhmad Yun Jufan</li><li>, Bambang Pujo Semedi</li><li>, Vanessy Theodora Silalahi</li><li>, Yudianto</li><li>, Erwin Pradian</li><li>, Achsanuddin Hanafie</li><li>, Mariza Fitriati</li><li>, Tinni Trihartini Maskoen</li><li>, Satriawan Abadi</li><li>, Calcarina Fitriani Retno Wisudarti</li><li>, Johan Arifin</li><li>, Reza Widyanto Sudjud</li><li>, Prananda Surya Airlangga</li><li>, Rupi’i</li><li>, I. Made Wiryana</li><li>, Anang Achmadi</li><li>, Patra Rijalul Harly</li><li>, Edward Kusuma</li><li>, Primartanto Wibowo</li><li>, Ade Veronica HY</li><li>, Jeni Sarah Mandang</li><li>, Meriwijanti</li><li>, I. Wayan Aryabiantara</li><li>, Faisal Muchtar</li><li>, Fachrul Jamal Isa</li><li>, Dita Aditianingsiih</li><li>, Nicolaas Parningotan Simamora</li><li>, Moch. Hasyim</li><li>, I. Gusti Putu Manuaba</li><li>, Novita Anggraeni</li><li>, Rudy Ariyanto Sanoesi</li><li>, Arief Munandar</li><li>, Duma Saurma Siahaan</li><li>, Sri Rachmawati</li><li>, Oky Susianto</li><li>, Liliriawati Ananta Kahar</li><li>, Zulkifli</li><li>, Mordekhai Leopold Laihad</li><li>, Nakada Takaaki</li><li>, Yoshitaka Hara</li><li>, Osamu Nishida</li><li>, Kenji Uehara</li><li>, Makoto Takatori</li><li>, Shinichiro Ohshimo</li><li>, Kazuya Kikutani</li><li>, Nobuaki Shime</li><li>, Shin Nunomiya</li><li>, Shinshu Katayama</li><li>, Bengo Atari</li><li>, Takashi Ito</li><li>, Yasuyuki Kakihana</li><li>, Kohei Takimoto</li><li>, Machi Yanai</li><li>, Moritoki Egi</li><li>, Tomoaki Yatabe</li><li>, Yuki Kishiara</li><li>, Ushio Higashijima</li><li>, Motohiro Sekino</li><li>, Kazuaki Atagi</li><li>, Hiroshi Ogura</li><li>, Tsunehiro Matsubara</li><li>, Tadashi Kamio</li><li>, Shigeki Fujitani</li><li>, Toru Yoshida</li><li>, Yukari Aoyagi</li><li>, Shigehiko Uchino</li><li>, Masatsugu Hasegawa</li><li>, Jun Oto</li><li>, Naoki Yamaguchi</li><li>, Yuki Enomoto</li><li>, Masaki Nakane</li><li>, G. S. Amirova</li><li>, Murat Daribaev</li><li>, Markov Viktor Evgenievich</li><li>, A. A. Vorobiev</li><li>, A. V. Andrushenko</li><li>, Aliya Torpakbaeva</li><li>, M. E. Konkayeva</li><li>, A. V. Galkin</li><li>, P. A. Ostanin</li><li>, Khamsay Detleuxay</li><li>, Noryani Mohd Samat</li><li>, Ismail Tan</li><li>, Nahla Irtiza Ismail</li><li>, Chew Har Lim</li><li>, Wan Nasrudin Wan Ismail</li><li>, Siti Rohayah Sulaiman</li><li>, Anita Alias</li><li>, Joanne Tiong Jia Wen</li><li>, Azmin Huda Abdul Rahim</li><li>, Asmah Zainudin</li><li>, Nik Azman Nik Adib</li><li>, Zihni Abdullah</li><li>, Hafizah</li><li>, Mohd Zulfakar Mazlan</li><li>, Mohd Basri Mat Nor</li><li>, Munkhasiakhan</li><li>, Naranpurev</li><li>, Cho Myint Tun</li><li>, Thinzar Maw</li><li>, Cho Cho</li><li>, Han Sein</li><li>, Myo Malar Win</li><li>, Lwin Lwin Hnin</li><li>, Cho Cho Lwin</li><li>, Aye Su Mon</li><li>, Yi Sandar Thein</li><li>, Khin Le Le Yi</li><li>, Myo Min Naing</li><li>, Nu Nu May</li><li>, Lun Naing</li><li>, Khin Saw Yu Aung</li><li>, Moe Thu Lin</li><li>, Aung Kyi</li><li>, Kyaw Min Min Tun</li><li>, Suu New Khin</li><li>, Khin Pyone Yi</li><li>, Khin May Waan</li><li>, Moe Thidar</li><li>, Kyi Kyi Sann</li><li>, Mu Mu Naing</li><li>, Win Win Mar</li><li>, Naing Naing Lin</li><li>, Lalit Rajbanshi</li><li>, Trishant Limbu</li><li>, Baburaja Shrestha</li><li>, Ujma Shrestha</li><li>, Ashish Shrestha</li><li>, Rosi Pradhan</li><li>, Ravi Ram Shrestha</li><li>, Sulav Acharya</li><li>, Pramesh Sunder Shrestha</li><li>, Puja Thapa Karki</li><li>, Moosa Awladthani</li><li>, Jacob Paul</li><li>, Nadia Al Badi</li><li>, Adil Al Kharusi</li><li>, Khalil Al Kharousi</li><li>, Sandeep Kantor</li><li>, Yohannan John</li><li>, Said Al Mandhari</li><li>, Geetha Jacob</li><li>, Amr Muhammad Esmat</li><li>, B. M. J. Shetty</li><li>, Ahmed Mostafa</li><li>, Naveed Haroon Rashid</li><li>, Muhammad Sohaib</li><li>, Sonia Joseph</li><li>, Safia Zafar</li><li>, Ahmed Farooq</li><li>, Muhammad Sheharyar Ashraf</li><li>, Tanveer Hussain</li><li>, Muhammad Hayat</li><li>, Ataur Rehman</li><li>, Syed Muneeb Ali</li><li>, Saad ur Rehman</li><li>, Ashok Kumar</li><li>, Aaron Hernandez</li><li>, Crystal Aperocho</li><li>, Raymundo Resurreccion</li><li>, Debbie Noblezada-Uy</li><li>, Jose Emmanuel Palo</li><li>, Julie Visperas</li><li>, Amer Asiri</li><li>, Ali Beshabshi</li><li>, Fahad Al-Hameed</li><li>, Ohoud Al Orabi</li><li>, Yaseen Arabi</li><li>, Eman Al Qasim</li><li>, Masood Iqbal</li><li>, Tharwat Aisa</li><li>, Mohammed Saeed Al Shahrani</li><li>, Laila Asonto</li><li>, Ayman Kharaba</li><li>, Abdullah al Mutairi</li><li>, Khaild Al Ghamdi</li><li>, Lama Hefni</li><li>, Ahmad Al Qurashi</li><li>, Galeb Al Makhlafi</li><li>, Roshni Sadashiv Gokhale</li><li>, Noelle Lim</li><li>, Manjit Pawar</li><li>, Venkatesan Kumaresh</li><li>, Naville Chia Chi Hock</li><li>, Tan Chee Keat</li><li>, Tan Rou An</li><li>, Jared De Souza</li><li>, Andrew Li</li><li>, Yip Hwee Seng</li><li>, Jason Phua</li><li>, Addy Tan YH</li><li>, Melvin Tay Chee Kiang</li><li>, Ng Shin Yi</li><li>, Ho Vui Kian</li><li>, Kiran Sharma</li><li>, Sennen Lew</li><li>, Lee Rui Min</li><li>, Do Wan Kim</li><li>, Yoon Mi Shin</li><li>, Song-I. Lee</li><li>, Kyung Chan Kim</li><li>, Yun-Seong Kang</li><li>, Soo Hwan Lee</li><li>, Ho Cheol Kim</li><li>, Yun Su Sim</li><li>, Sunghoon Park</li><li>, Tai Sun Park</li><li>, Hongyeul Lee</li><li>, Youjin Chang</li><li>, Heung Bum Lee</li><li>, Je Hyeong Kim</li><li>, Young Seok Lee</li><li>, Won Gun Kwack</li><li>, In Byung Kim</li><li>, Tae Yun Park</li><li>, Young Jae Cho</li><li>, Sang-Min Lee</li><li>, Kyeongman Jeon</li><li>, Jongmin Lee</li><li>, Shin Young Kim</li><li>, Jin-Won Huh</li><li>, Jong Joon Ahn</li><li>, Jae Hwa Cho</li><li>, Won-Yeon Lee</li><li>, Chin-Kuo Lin</li><li>, Chang-Ke Chu</li><li>, Jiun-Ting Wu</li><li>, Chiung-Yu Lin</li><li>, Yu-Mu Chen</li><li>, Kuo-Tung Huang</li><li>, Han-Chung Hu</li><li>, Cong-tat Cia</li><li>, Jung-Yien Chien</li><li>, Chun-Te Huang</li><li>, Pin-Kuei Fu</li><li>, Nattachai Srisawas</li><li>, Manasnun Kongwibulwut</li><li>, Kaweesak Chittawatanarat</li><li>, Worapot Daewtrakulchai</li><li>, Anakapong Phunmanee</li><li>, Anupol Panitchote</li><li>, Boonsong Patjanasoontorn</li><li>, Chaiwut Sawawiboon</li><li>, Lê Minh Trung</li><li>, Đỗ Ngọc Sơn</li><li>, B. S. Bùi Nhật Hà</li><li>, Dương Thiện Phước</li><li>, Huỳnh Quang Đại</li><li>, Nguyễn Tấn Hùng</li><li>, Lê Thị Phương Thúy</li><li>, Hoàng Bùi Hải</li><li>, Hoàng Trọng Ái Quốc</li><li>, Trần Hoài Linh</li><li>, Vũ Hải Yến</li><li>, Phạm Trà Giang</li><li>, Nguyễn Thị Ngà</li><li> & Nguyễn Đăng Tuân</li></ul><h3>for the Asian Critical Care Clinical Trials Group</h3><h3>Contributions</h3><p>LL wrote the first draft of the manuscript. AL and JP provided critique of the manuscript and approved it for submission.</p><h3>Corresponding author</h3><p>Correspondence to Lowell Ling.</p><h3>Ethics approval and consent to participate</h3>\n<p>The National Healthcare Group Domain-Specific Review Board approved the study (2018/00354), with a waiver informed consent as this was an observational study. In addition this study was approved by institutional review boards according to local regulations at participating ICUs, with most waiving the need for informed consent.</p>\n<h3>Competing interests</h3>\n<p>The authors declare no competing interests.</p><h3>Publisher's Note</h3><p>Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.</p><h3><b>Additional file 1.</b></h3><p> Contributing centers listed alphabetically per country/region with Lead Investigators and Co-Investigators.</p><p><b>Open Access</b> This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.</p>\n<p>Reprints and permissions</p><img alt=\"Check for updates. 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Abstract

We thank Wang and Zhong for raising the important considerations on limitation or withdrawal of therapy in the MOSAICS II studies [1]. Although limitation or withdrawal of therapy was not part of the exclusion criteria for MOSACIS II, data on subsequent limitation of therapy or withdrawal of therapy during ICU stay was collected but not previously published [2, 3]. Amongst the 4826 patients included in the MOSACIS II secondary analysis on qSOFA prognostic value, only 5.9% (283/4826) had withdrawal of life-sustaining treatments and 5.9% (287/4826) had withholding of life-sustaining treatments [3]. Even amongst those who died within 28 days, only 11.2% (142/1271) and 10.8% (137/1271) had withdrawal or withholding of life-sustaining treatments prior to death. Overall, low rates of limitation of therapy suggest it may not have significantly biased the conclusions drawn about prognostic value of qSOFA in sepsis.

The Asian Critical Care Clinical Trials group have previously published multiple survey studies on end-of-life practices in Asian ICUs [4,5,6]. However, real-life observations on end-of-life practices in MOSAICS II seem discrepant to these survey results. The ACME study reported that 70.2% of Asian ICU physicians would almost always or often withhold life-sustaining treatments and 20.7% would withdraw such treatments for patients with no real chance of recovering meaningful life [4]. The low observed rates of limitation of therapy in MOSAICS II may reflect the perception that limitation of life-sustaining treatment may expose the physician to legal risks [5]. Furthermore, there is significant variations in practice across cultures and income settings. As Wang and Zhong highlighted, Chinese physicians are more likely to consider financial burden when considering limiting life-sustaining treatments [6].

We appreciate the suggestions made by Wang and Zhong and agree that variations in local end-of-life practices may impact clinical research and care of critically ill patients in Asian ICUs. More prospective data are needed to understand the cultural and religious, financial and contextual factors that shape end-of-life practices in ICUs.

The data that support the findings of this study are available from the corresponding author upon reasonable request.

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MOSAICS II Study Group: The study sites and investigators who contributed to recruitment and data collection are listed in Additional file 1.

This was not a funded study.

Authors and Affiliations

Department of Anaesthesia and Intensive Care, The Chinese University of Hong Kong, Hong Kong SAR, China
Lowell Ling
Division of Respiratory and Critical Care Medicine, Department of Medicine, National University Hospital, National University Health System, Singapore, Singapore
Andrew Li & Jason Phua
FAST and Chronic Programmed, Alexandra Hospital, National University Health System, Singapore, Singapore
Jason Phua

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Lowell LingView author publications
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Andrew LiView author publications
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Jason PhuaView author publications
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Consortia

the MOSAICS II Study Group

Uzzal Kumar Mallick
, Motiul Islam
, Tarequl Hamid
, A. K. M. Shirazul Islam
, Rabiul Halim
, Md Arifur Rahman Khan
, Mohammad Asaduzzaman
, Md Rezaul Karim
, Nahim Sarwar
, Shamsul Hoque Milon
, Rashed Mahmud
, A. K. M. Sirajul Islam Hirok
, Ashraful Haque
, Amina Sultana
, Mir Atiqur Rahman Shajal
, Farha Andalib
, Rashedul Hasan
, Khalid Mahmood Khan Nafees
, Shah Sudhirchandra Dhansukhlal
, Ning Li
, Xiaowei Liu
, Haiwei Yang
, Ming Hou
, Ying Li
, Jian Zhang
, Lifeng Huang
, Wenxiong Li
, Meili Duan
, Taotao Liu
, Wei He
, Fangyu Ning
, Xiaozhi Wang
, Xiaoyan Zhou
, Sun Yu
, Xiang Xiang
, Liang Pan
, Feihu Zhou
, Yaoli Wang
, Jian Zhou
, Tao Wang
, Xuefei Yang
, Yu Ma
, Xuan Song
, Haiying Wu
, Chuanyun Qian
, Lixin Zhou
, Zuohang Xu
, Kun Zhang
, Zhenjie Hu
, Xingsheng Lin
, Songjing Shi
, Xiaoguang Zhang
, Rongguo Yu
, Liqin Zhang
, Yuan Yuan
, Huiru Zhou
, Xiandong Wang
, Zhonghua Wang
, Tiehe Qin
, Xianqing Shi
, Rui Li
, Zhenyang He
, Xiangrong Zuo
, Quan Cao
, Tao He
, Yuanda Sui
, Tiejun Wu
, Ying Xu
, Qin Gu
, Weizheng Shuai
, Hanyu Qin
, Bin Du
, Hong Qiao
, Shuangling Li
, Guiying Dong
, Xiujuan Zhao
, Fengxue Zhu
, Junshi Wang
, Lei Huang
, Tianchang Wang
, Hao Wang
, Siqing Ma
, Zhengping Yang
, Yuan Gao
, Ruoming Tan
, Yun Xie
, Ruilan Wang
, Jia Jia
, Bin Zang
, Jun Wang
, Ling Lin
, Yuwen Wu
, Yunfu Wu
, Penglin Ma
, Yanfang Li
, Li Yu
, Rui Guo
, Jiuzhi Zhang
, Xianyao Wan
, Feng Shen
, Qindong Shi
, Jun Xu
, Qiang Fang
, Shaohua Liu
, Tongwen Sun
, Mian Zeng
, Weiyun Pan
, Zhongmin Liu
, Qingling Lin
, Nan Wang
, Jing Pang
, Bin Xiong
, Deliang Wen
, Fuxin Kang
, Liuhui Chang
, Yun Sun
, Jingxiao Zhang
, Yongjie Yin
, Liu Qing
, Jiajun Sun
, Nahui Li
, Yongqiang Wang
, Songtao Shou
, Yanfen Chai
, Lei Xu
, Xiaobo Yang
, Xuelian Liao
, Xian Kang
, Shuangping Zhao
, Liquan Huang
, Run Zhang
, Renhua Sun
, Chao Shen
, Yan He
, Fu Loi Chow
, Michele Tang
, Philip Lam
, Esther Cham
, Kin Bong Tang
, Lowell Ling
, Manimala Dharmangadan
, Pauline Yeung Ng
, Kin Ho Ling
, Vincent Lau
, Samir Sahu
, Sharmila Chatterjee
, Sushmita Basu
, Zubair Umer Mohamed
, Sudeep Sirga
, Siddhartha Reddy Kasireddy
, M. A. Aleem
, Swarna Deepak Kuragayala
, Sai Praveen Haranath
, Nagarajan Ramakrishnan
, Pravin Amin
, Joanne Mascarenhas
, Radhika Dash
, Venkat Raman Kola
, R. Vaidyanathan
, Siddharth Agarwal
, Pradip K. Bhattacharya
, Deepak Jeswani
, Parshotum Lal Gautam
, Abdul Samad Ansari
, Vivek Nangia
, Mrinal Sircar
, V. M. Balasubramani
, S. Maneendra
, Sanghamitra Mishra
, Anjeev Kumar
, Rajesh Chawla
, Trevor Francis Sequeira
, Om Prakash Shrivastava
, T. V. Sreevalsan
, Rajesh Mohan Shetty
, Manjunath Thimmappa
, M. M. Harish
, Yatin Mehta
, Divya Saxena
, Vipul Mishra
, Rishi Kumar
, Simnt Kumar Jha
, Prashant Sakhavalkar
, Dnyaneshwar Diwane
, Subhal Dixit
, Kalaiselvan
, Manoranjan Pattnaik
, Lalit Singh
, Fareed Khan
, Mehul Shah
, Prasanna
, Ziokov Joshi
, Sheila Ninan Myatra
, Manoj Gorade
, Bharat G. Jagiasi
, Amol Hartalkar
, B. Saroj Kumar Prusty
, Yogesh
, Ade Winata
, Maulydia
, Surya Oto Wijaya
, Hermin Prihartini
, Shinta V. R. Hutajulu
, Rudy Manalu
, Christrijogo Sumartono
, Chrisma Adryana Albandjar
, Ira Pitaloka
, Dewi Kusumawati
, Arifin
, Akhmad Yun Jufan
, Bambang Pujo Semedi
, Vanessy Theodora Silalahi
, Yudianto
, Erwin Pradian
, Achsanuddin Hanafie
, Mariza Fitriati
, Tinni Trihartini Maskoen
, Satriawan Abadi
, Calcarina Fitriani Retno Wisudarti
, Johan Arifin
, Reza Widyanto Sudjud
, Prananda Surya Airlangga
, Rupi’i
, I. Made Wiryana
, Anang Achmadi
, Patra Rijalul Harly
, Edward Kusuma
, Primartanto Wibowo
, Ade Veronica HY
, Jeni Sarah Mandang
, Meriwijanti
, I. Wayan Aryabiantara
, Faisal Muchtar
, Fachrul Jamal Isa
, Dita Aditianingsiih
, Nicolaas Parningotan Simamora
, Moch. Hasyim
, I. Gusti Putu Manuaba
, Novita Anggraeni
, Rudy Ariyanto Sanoesi
, Arief Munandar
, Duma Saurma Siahaan
, Sri Rachmawati
, Oky Susianto
, Liliriawati Ananta Kahar
, Zulkifli
, Mordekhai Leopold Laihad
, Nakada Takaaki
, Yoshitaka Hara
, Osamu Nishida
, Kenji Uehara
, Makoto Takatori
, Shinichiro Ohshimo
, Kazuya Kikutani
, Nobuaki Shime
, Shin Nunomiya
, Shinshu Katayama
, Bengo Atari
, Takashi Ito
, Yasuyuki Kakihana
, Kohei Takimoto
, Machi Yanai
, Moritoki Egi
, Tomoaki Yatabe
, Yuki Kishiara
, Ushio Higashijima
, Motohiro Sekino
, Kazuaki Atagi
, Hiroshi Ogura
, Tsunehiro Matsubara
, Tadashi Kamio
, Shigeki Fujitani
, Toru Yoshida
, Yukari Aoyagi
, Shigehiko Uchino
, Masatsugu Hasegawa
, Jun Oto
, Naoki Yamaguchi
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, Tanveer Hussain
, Muhammad Hayat
, Ataur Rehman
, Syed Muneeb Ali
, Saad ur Rehman
, Ashok Kumar
, Aaron Hernandez
, Crystal Aperocho
, Raymundo Resurreccion
, Debbie Noblezada-Uy
, Jose Emmanuel Palo
, Julie Visperas
, Amer Asiri
, Ali Beshabshi
, Fahad Al-Hameed
, Ohoud Al Orabi
, Yaseen Arabi
, Eman Al Qasim
, Masood Iqbal
, Tharwat Aisa
, Mohammed Saeed Al Shahrani
, Laila Asonto
, Ayman Kharaba
, Abdullah al Mutairi
, Khaild Al Ghamdi
, Lama Hefni
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, Galeb Al Makhlafi
, Roshni Sadashiv Gokhale
, Noelle Lim
, Manjit Pawar
, Venkatesan Kumaresh
, Naville Chia Chi Hock
, Tan Chee Keat
, Tan Rou An
, Jared De Souza
, Andrew Li
, Yip Hwee Seng
, Jason Phua
, Addy Tan YH
, Melvin Tay Chee Kiang
, Ng Shin Yi
, Ho Vui Kian
, Kiran Sharma
, Sennen Lew
, Lee Rui Min
, Do Wan Kim
, Yoon Mi Shin
, Song-I. Lee
, Kyung Chan Kim
, Yun-Seong Kang
, Soo Hwan Lee
, Ho Cheol Kim
, Yun Su Sim
, Sunghoon Park
, Tai Sun Park
, Hongyeul Lee
, Youjin Chang
, Heung Bum Lee
, Je Hyeong Kim
, Young Seok Lee
, Won Gun Kwack
, In Byung Kim
, Tae Yun Park
, Young Jae Cho
, Sang-Min Lee
, Kyeongman Jeon
, Jongmin Lee
, Shin Young Kim
, Jin-Won Huh
, Jong Joon Ahn
, Jae Hwa Cho
, Won-Yeon Lee
, Chin-Kuo Lin
, Chang-Ke Chu
, Jiun-Ting Wu
, Chiung-Yu Lin
, Yu-Mu Chen
, Kuo-Tung Huang
, Han-Chung Hu
, Cong-tat Cia
, Jung-Yien Chien
, Chun-Te Huang
, Pin-Kuei Fu
, Nattachai Srisawas
, Manasnun Kongwibulwut
, Kaweesak Chittawatanarat
, Worapot Daewtrakulchai
, Anakapong Phunmanee
, Anupol Panitchote
, Boonsong Patjanasoontorn
, Chaiwut Sawawiboon
, Lê Minh Trung
, Đỗ Ngọc Sơn
, B. S. Bùi Nhật Hà
, Dương Thiện Phước
, Huỳnh Quang Đại
, Nguyễn Tấn Hùng
, Lê Thị Phương Thúy
, Hoàng Bùi Hải
, Hoàng Trọng Ái Quốc
, Trần Hoài Linh
, Vũ Hải Yến
, Phạm Trà Giang
, Nguyễn Thị Ngà
& Nguyễn Đăng Tuân

for the Asian Critical Care Clinical Trials Group

Contributions

LL wrote the first draft of the manuscript. AL and JP provided critique of the manuscript and approved it for submission.

Corresponding author

Correspondence to Lowell Ling.

Ethics approval and consent to participate

The National Healthcare Group Domain-Specific Review Board approved the study (2018/00354), with a waiver informed consent as this was an observational study. In addition this study was approved by institutional review boards according to local regulations at participating ICUs, with most waiving the need for informed consent.

Competing interests

The authors declare no competing interests.

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Ling, L., Li, A., Phua, J. et al. Limitation of life-sustaining treatments in Asian ICUs: theory versus practice. Crit Care 29, 9 (2025). https://doi.org/10.1186/s13054-024-05241-2

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Received: 24 December 2024
Accepted: 29 December 2024
Published: 06 January 2025
DOI: https://doi.org/10.1186/s13054-024-05241-2

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亚洲icu维持生命治疗的局限性：理论与实践

我们感谢Wang和Zhong在MOSAICS II研究中提出限制或停药的重要考虑[10]。虽然限制或停止治疗不是MOSACIS II的排除标准的一部分，但收集了ICU住院期间随后限制治疗或停止治疗的数据，但先前未发表[2,3]。在MOSACIS II二次分析qSOFA预后价值的4826例患者中，只有5.9%（283/4826）的患者停止了维持生命的治疗，5.9%（287/4826）的患者停止了维持生命的治疗。即使在28天内死亡的人中，也只有11.2%（142/1271）和10.8%（137/1271）在死前停止或停止了维持生命的治疗。总的来说，较低的治疗限制率表明，qSOFA在脓毒症中的预后价值的结论可能没有明显偏差。亚洲重症监护临床试验小组此前发表了多项关于亚洲icu临终实践的调查研究[4,5,6]。然而，现实生活中对MOSAICS II临终实践的观察似乎与这些调查结果不一致。ACME的研究报告称，70.2%的亚洲ICU医生几乎总是或经常停止维持生命的治疗，20.7%的医生会对没有真正机会恢复有意义的生活的患者停止这种治疗。在MOSAICS II中观察到的治疗限制率较低，这可能反映了一种观念，即生命维持治疗的限制可能使医生面临法律风险。此外，在不同的文化和收入背景下，实践也存在显著差异。正如Wang和钟所强调的那样，中国医生在考虑限制维持生命的治疗时更有可能考虑经济负担。我们赞赏Wang和Zhong提出的建议，并同意当地临终实践的差异可能会影响亚洲icu重症患者的临床研究和护理。需要更多的前瞻性数据来了解影响icu临终实践的文化和宗教、财务和环境因素。支持本研究结果的数据可根据通讯作者的合理要求提供。王敏，钟磊。亚洲地区脓毒症流行病学调查的思考。危重症护理，2024;28(1):59。[文章]李安，凌玲，秦海，Arabi YM, Myatra SN, Egi M，等。亚洲不同国家的icu脓毒症流行病学、管理和结局。[J] .呼吸与危重症杂志。2012;26(9):1107 - 1106。学者李安，凌玲，秦海，Arabi YM, Myatra SN, Egi M，等。不同收入环境下ICU脓毒症患者快速序贯器官衰竭评估评分的预后评价。危重症护理，2024;28(1):30。Phua J, joint GM, Nishimura M, Deng Y, Myatra SN, Chan YH，等。在亚洲的重症监护病房中停止和停止维持生命的治疗。中华医学杂志，2015;17(3):363-71。Phua J, joint GM, Nishimura M, Deng Y, Myatra SN, Chan YH，等。亚洲中低收入国家和地区与高收入国家和地区停止和停止维持生命治疗的情况。重症监护医学，2016;42(7):1118-27。[文章]学者Park SY， Phua J, Nishimura M, Deng Y, Kang Y, Tada K，等。东亚icu临终关怀：中国、韩国和日本的比较。危重病护理，2018;46(7):1114-24。mosaics II研究组：在附加文件1中列出了参与招募和数据收集的研究地点和研究者。这不是一项受资助的研究。作者及单位：香港中文大学麻醉及重症监护科（中国香港特别行政区）lingwell新加坡国立大学卫生系统国立大学附属医院医学部呼吸及重症监护医学系（新加坡）andrew Li &；新加坡国立大学卫生系统亚历山德拉医院的Jason phufast和Chronic Programmed，新加坡jason phuaauthorslowwell LingView作者出版物您也可以在PubMed谷歌ScholarAndrew LiView作者出版物中搜索该作者您也可以在PubMed谷歌ScholarJason PhuaView作者出版物中搜索该作者您也可以在PubMed谷歌ScholarConsortiathe MOSAICS II Study GroupUzzal Kumar Mallick， Motiul Islam, Tarequl Hamid, a.k. m Shirazul Islam, Rabiul Halim, Md Arifur Rahman Khan, Mohammad Asaduzzaman, Md Rezaul Karim， Nahim中搜索该作者Sarwar, Shamsul Hoque Milon, Rashed Mahmud, a.k. M。 Ostanin, Khamsay Detleuxay, Noryani Mohd Samat, Ismail Tan, Nahla Irtiza Ismail, Chew Har Lim, Wan Nasrudin Wan Ismail, Siti Rohayah Sulaiman, Anita Alias, Joanne Tiong Jia Wen, Azmin Huda Abdul Rahim, Asmah Zainudin, Nik Azman Nik Adib, Zihni Abdullah, Hafizah, Mohd Zulfakar Mazlan, Mohd Basri Mat Nor, munkasiakhan，Naranpurev,秋敏吞Thinzar胃,秋秋,汉盛,Myo颧骨赢,伦伦Hnin,曹曹伦,啊苏莫,易Sandar登,钦乐乐,Myo敏哥奈,νν,Lun奈,钦看到于昂,林莫邱,昂山苏姬,觉敏敏桶,素新钦钦Pyone咦,钦Waan, Moe Thidar,苏姬苏姬君,μμ耶,胜利赢得3月,奈奈林,Lalit Rajbanshi Trishant Limbu, Baburaja Shrestha, Ujma Shrestha,阿施施施Rosi Pradhan,拉维Ram Shrestha Sulav Acharya, PrameshSunder Shrestha, Puja Thapa Karki, Moosa Awladthani, Jacob Paul, Nadia Al Badi, Adil Al Kharusi, Khalil Al Kharousi, Sandeep Kantor, Yohannan John, Said Al Mandhari, Geetha Jacob, Amr Muhammad Esmat, b.m.j. Shetty, Ahmed Mostafa, Naveed Haroon Rashid, Muhammad Sohaib, Sonia Joseph, Safia Zafar, Ahmed Farooq, Muhammad Sheharyar Ashraf, Tanveer Hussain, Muhammad Hayat, Ataur Rehman, Syed Muneeb Ali, Saad ur Rehman, Ashok Kumar, Aaron Hernandez, Crystal Aperocho, Raymundo Resurreccion, DebbieNoblezada-Uy, Jose Emmanuel Palo, Julie Visperas, Amer Asiri, Ali Beshabshi, Fahad Al- hameed, Ohoud Al Orabi, Yaseen Arabi, Eman Al Qasim, Masood Iqbal, Tharwat asia, Mohammed Saeed Al Shahrani, Laila Asonto, Ayman Kharaba, Abdullah Al Mutairi, Khaild Al Ghamdi, Lama Hefni, Ahmad Al Qurashi, Galeb Al Makhlafi, Roshni Sadashiv Gokhale, Noelle Lim, Manjit Pawar, Venkatesan Kumaresh, Naville Chia Chi Hock, Tan Chee Keat, Tan Rou An, Jared De Souza, Andrew Li, Yip Hwee Seng, Jason Phua, Addy TanYH, Melvin Tay Chee jiang, Ng Shin Yi, Ho Vui Kian Sharma, Sennen Lew, Lee Rui Min, Do Wan Kim, Yoon Mi Shin, Song-I。Lee Kyung Chan Kim Yun-Seong Kang秀青紫色李,何鸿燊Cheol Kim Yun苏Sim, Sunghoon公园,大太阳公园,Hongyeul Lee Youjin Chang草根阶层的屁股李,我Hyeong金,年轻的李Seok,获得枪支Kwack在Byung Kim Tae Yun公园,年轻的Jae曹,引人注意李,全度妍Kyeongman Jongmin Lee Shin年轻的金,进得了哈,郑大世俊安,Jae赵月,Won-Yeon Lee Chin-Kuo Lin Chang-Ke楚、吴Jiun-Ting Chiung-Yu Lin Yu-Mu Chen Kuo-Tung黄Han-Chung Hu Cong-tat中情局,Chun-Te Jung-Yien简,黄、傅Pin-Kuei Nattachai Srisawas, Manasnun Kongwibulwut, Kaweesak Chittawatanarat, Worapot Daewtrakulchai, Anakapong Phunmanee, Anupol Panitchote, Boonsong Patjanasoontorn, Chaiwut Sawawiboon, Le明TrungĐỗNgọc Sơn, Bui Nhậb S t哈,DươNg Thiện Phước,胡ỳNh QuangĐạ我Nguyễn tấn挂,Le ThịPhươNg Thuy黄平君Bui Hả我黄平君TrọNg瞿Aiốc, n TrầHoai灵,VũHả我Yến, Ph值ạm交易江,NguyễnịNga,Nguyễn Đăng tu<e:1>为亚洲重症监护临床试验小组的贡献，ll撰写了手稿的初稿。AL和JP对手稿进行了评论并批准了提交。通讯作者：Lowell Ling。国家医疗保健集团特定领域审查委员会批准了该研究（2018/00354），并放弃知情同意，因为这是一项观察性研究。此外，这项研究是由机构审查委员会根据参与icu的当地法规批准的，其中大多数放弃了知情同意的需要。利益竞争作者声明没有利益竞争。出版商声明：对于已出版的地图和机构关系中的管辖权要求，普林格·自然保持中立。附加文件1。贡献中心按国家/地区的字母顺序列出，主要研究者和共同研究者。开放获取本文遵循知识共享署名-非商业-非衍生品4.0国际许可协议，该协议允许以任何媒介或格式进行非商业用途、共享、分发和复制，只要您适当注明原作者和来源，提供知识共享许可协议的链接，并注明您是否修改了许可材料。根据本许可协议，您无权分享源自本文或其部分内容的改编材料。本文中的图像或其他第三方材料包含在文章的知识共享许可协议中，除非在材料的署名中另有说明。如果材料未包含在文章的知识共享许可中，并且您的预期用途不被法律法规允许或超过允许的用途，您将需要直接获得版权所有者的许可。要查看本许可证的副本，请访问http://creativecommons.org/licenses/by-nc-nd/4.0/.Reprints和permissionsCite这篇文章ling， L., Li, a ., Phua， J.等。亚洲icu维持生命治疗的局限性：理论与实践。危重护理29,9（2025）。 https://doi.org/10.1186/s13054-024-05241-2Download citation：收稿日期：2024年12月24日接受日期：2024年12月29日发布日期：2025年1月6日doi: https://doi.org/10.1186/s13054-024-05241-2Share这篇文章任何你分享以下链接的人都可以阅读到这篇文章：获取可共享链接对不起，本文目前没有可共享链接。复制到剪贴板由施普林格自然共享内容倡议提供

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来源期刊

Critical Care 医学-危重病医学

CiteScore

20.60

自引率

3.30%

发文量

348

审稿时长

1.5 months

期刊介绍： Critical Care is an esteemed international medical journal that undergoes a rigorous peer-review process to maintain its high quality standards. Its primary objective is to enhance the healthcare services offered to critically ill patients. To achieve this, the journal focuses on gathering, exchanging, disseminating, and endorsing evidence-based information that is highly relevant to intensivists. By doing so, Critical Care seeks to provide a thorough and inclusive examination of the intensive care field.