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Fig.1.

Patient flow chart
Patient flow chart

Fig.2.

Total patients cost per category.
Total patients cost per category.

Type of Limited NBIs

Limited NBIs (n, %) (N=164)
Vasoactive drugs 128 (78,0)
Invasive mechanical ventilation 95 (57,9)
Noninvasive mechanical ventilation 27 (16,5)
Continuous renal replacement techniques 17 (10,4)

Cost category per patient before and after the limitation of NBIs

Cost category per patient Mean(SD) P value
Variable cost (before) 2666,13 (3306,89) 0,001
Variable cost (after) 556,6 (735,3)

Fixed direct costs (before) 3269,52 (4173,84) 0,001
Fixed direct costs (after) 1514,76 (1759,64)

Fixed indirect costs (before) 833,86 (1064,5) 0,001
Fixed indirect costs (after) 366,33 (448,78)

Total cost (before) 6769,53 (8331,59) 0,001
Total cost (after) 2457,7 (2652,68)

Daily cost (before) 767,31 (405,52) 0,001
Daily cost (after) 649,12 (243,14)

Patients’ characteristics

Patients’ characteristics All patients(N=454) Patients with no limitation of NBIs (N=290) Patients with limited NBIs (N=164) P-value
Gender–Male, n(%) 304 (67,0) 195 (67,2) 109 (66,5) 0,866
Age, median (IQR) 65 (21) 62 (22) 70 (14) 0,000
APACHE IV, median (IQR) 58 (35) 50 (31) 71 (42) 0,000
APACHE IV PDR, median (IQR) 28,4 (36,6) 17,35 (27,2) 48,9 (31,9) 0,000
LOS, median (IQR) 5 (12) 4,5 (11) 7 (13) 0,004

Reason for admission n (%)
Surgery 99 (21,81) 92 (31,7) 7 (4,3) 0,001
Acute respiratory failure (COVID-19) 95 (20,93) 41 (14,1) 54 (32,9) 0,001
Acute Respiratory Failure 59 (13) 41 (14,1) 18 (11,0) 0,385
Traumatic brain injury 43 (9,47) 22 (7,6) 21 (12,8) 0,094
Nontraumatic CNS injuries 43 (9,47) 25 (8,6) 18 (11,0) 0,409
Cardiac arrest 33 (7,27) 11 (3,8) 22 (13,4) 0,001
Sepsis 25 (5,51) 11 (3,8) 14 (8,5) 0,052
Multiple trauma 18 (3,96) 17 (5,9) 1 (0,6) 0,005
Multiple trauma (with TBI) 14 (3,08) 9 (3,1) 5 (3,0) 0,607
Other 25 (5,51) 21 (7,2) 4 (2,4) 0,033

Comorbidities at ICU admission n (%)
Chronic pulmonary disease 72 (15,9) 36 (12,4) 36 (22,0) 0,011
Cardiovascular disease 134 (29,5) 80 (29,5) 54 (32,9) 0,412
Chronic kidney disease 26 (5,7) 8 (2,8) 18 (11,0) 0,001
Hypertension 170 (37,4) 96 (33,1) 74 (45,1) 0,012
Disorders of thyroid gland 31 (6,8) 20 (6,9) 11 (6,7) 0,553
Diabetes mellitus 88 (19,4) 46 (15,9) 42 (25,6) 0,014
Cancer 39 (8,6) 26 (9,0) 13 (7,9) 0,862
Obesity 22 (4,8) 11 (3,8) 11 (6,7) 0,177
Other 186 (41,0) 128 (44,1) 58 (35,4) 0.074

ICU mortality, n (%) 173 (38,1) 30 (10,3) 143 (87,2) 0,000
60 days hospital mortality, n (%) 218 (48,0) 58 (20,0) 160 (97,6) 0,000
SMR, 95% Confidence Interval (CI) 1,18 (0.88–1.58) 0,47 (0.28–0.78) 1,74 (1.55–2.05)
Variable costs per patient, mean (SD) 3111,87 (4306,06) 3047,71 (4661,21) 3226,02 (3599,26) 0,017
Fixed direct costs per patient, mean (SD) 4263,75 (5029,56) 3969,38 (5010,92) 4798,06 (5047,95) 0.004
Fixed indirect costs per patient, mean (SD) 1087,44 (1282,75) 1012,36 (1278,00) 1223,72 (1287,44) 0,004
Total cost per patient, mean (SD) 8467,85 (10179,37) 8029,46 (10490,42) 9247,79 (9582,97) 0,004
Average daily cost per patient, mean (SD) 832,10 (163,82) 832,59 (159,46) 831,24 (171,80) 0,716

Length of stay in ICU of patients with limitation of NBIs

LOS (in ICU) Withholding NBIs Withdrawing NBIs
Before decision After decision Before decision After decision
N 123 41
Mean 8,93 3,94 4,12 2,49
SD 10,94 4,44 3,68 2,94
Median 6 2 3 2
IQR 12 4 4 3
Min 1 1 1 1
Max 64 27 15 17
Sum 1098 485 169 102
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