Futile therapy in critically ill patients from the perspective of anesthetists: a questionnaire study

Introduction: Futile therapy prevention in critically ill patients is regulated by the 2014 guidelines of the Polish Society of Anesthesiology and Intensive Therapy. With advanced technological capabilities to replace vital organ functions, it is crucial to prevent futile therapy, which prolongs suffering and deprives patients of a dignified death. This questionnaire study aimed to examine futile therapy from the perspective of anesthesiologists, focusing on their perceptions and the factors influencing their decisions in the area of intensive care. Participants and methods: An anonymous online survey conducted in early 2024 gathered responses from 113 anesthesiologists. Respondents with less than 33% of their work time in Intensive Care Units (ICUs) (n = 37), those without futility protocols in their hospitals (n = 19), and those working in ICUs with fewer than six beds (n = 5) were excluded. The final analysis included 52 respondents (average age 46 years, 58% female). Results: Futility therapy protocols were introduced in 79% of workplaces, primarily in university hospitals (96%), provincial hospitals (78%), and infrequently in municipal hospitals (59%). Procedures linked to futile therapy included renal replacement therapy (98%), extracorporeal gas exchange (98%), cardiopulmonary resuscitation (97%), pharmacological circulatory support (90%), and blood transfusions (86%). Factors influencing decisions included neurological damage (100%), pre-admission functional status (88%), and chronic disease burden (82%). Barriers included legal concerns (90%), family insistence (75%), and ethical dilemmas (55%). Time-limited trials were not used in 54% of centers despite being considered necessary. Conclusions: Futile therapy remains controversial. Updated guidelines addressing anesthesiologists’ concerns and practical challenges are needed to improve decision-making and patient care.