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The following is a summary of “Advance directives in the intensive care unit: An eight-year vanguard cohort study,” published in the February 2025 issue of Journal of Critical Care by Baumann et al. 

Researchers conducted a retrospective study to analyze the frequency, content, and clinical application of advance directives in intensive care units (ICUs).  

They analyzed data from a Swiss tertiary ICU, focusing on individuals with advance directives who received ICU care for at least 48 hours. The primary outcome measured was the extent of directive violations and secondary outcomes included the prevalence of advance directives and application in clinical practice (ICU ≥48 h). 

The results showed that among 5,851 individuals who received ICU treatment for at least 48 hours, 2.7% had documented advance directives. Although 92% utilized standardized templates, 19% contained subjective language, and 12% had contradictory statements. Violations of directives occurred in 9% of cases. Those experiencing directive violations had poorer in-hospital outcomes (P = 0.012). At the time of admission, 64% of individuals with directive violations were unable to communicate, while 30% had directives that were either missing or unrecognized. Most violations involved life-prolonging interventions (6%), ICU admission (5%), and mechanical ventilation (3%). Kaplan-Meier analysis indicated a lower survival rate when directives were acknowledged at admission (P = 0.04) and when treatment was withheld (P < 0.001) (ICUs ≥48 h).  

Investigators concluded that while physicians generally respected advance directives and adapted treatment accordingly, a minority of patients admitted to ICU had them, and violations correlated with negative outcomes. 

Source: sciencedirect.com/science/article/pii/S0883944124004052