Background. Modern intensive care methods led to an increased survival of critically ill patients over the last decades. But an unreflected application of modern intensive care measures might lead to prolonged treatment for incurable diseases, and an inadaequate or too aggressive therapy can prolong the dying process of patients. In this study, we analysed end-of-life decisions regarding withholding and withdrawal of intensive care measures in a German intensive care unit (ICU) of a communal tertiary hospital. Methods. Patient datasets of all adult patients dying in an ICU or an intermediate care unit (IMC) in a tertiary communal hospital (Klinikum Hanau, Germany) between 01.01.2011 and 31.12.2012 were analysed for withholding and withdrawal of intensive care measures. Results. During the two-year period, 1317 adult patients died in Klinikum Hanau. Of these, 489 (37%) died either in an ICU/IMC unit. The majority of those deceased patients (n = 427, 87%) was 60 years or older. In 306 (62%) of 489 patients, at least one life-sustaining measure was withheld or withdrawn. In 297 (61%) of 489 patients dying in ICU/IMC, any type of therapy was withheld, and in 139 patients (28%), any type of therapy was withdrawn. Mostly, cardiopulmonary resuscitation (n = 222), invasive (n = 121) and noninvasive (n = 40) ventilation followed by renal replacement therapy (n = 71) and catecholamine therapy (n = 66) were withheld. More invasive measures as ventilation or renal replacement therapy were withdrawn in 18 and 22 patients only. After withholding/withdrawal of therapy, most patients died within two days. More than 20% of patients dying in ICU/IMC did not have an analgesic medication. Conclusions. About one-third of patients dying in the hospital died in ICU/IMC. At least one life-sustaining therapy was limited/withdrawn in more than 60% of those patients. Withholding of a therapy was more common than active therapy withdrawal. Ventilation and renal replacement therapy were withdrawn in less than 5% of patients, respectively.

In this paper, a sensitive and simple zirconium nanoparticles (Zr-NPs) based vortex assisted ligandless dispersive solid phase extraction (VA-LDSPE) method was developed for the preconcentration of lead from wastewater samples for the determination by slotted quartz tube-flame atomic absorption spectrometry (SQT-FAAS). Zr-NPs were synthesized using zirconium (IV) chloride salt as a starting material through a simple reduction process with sodium borohydride, and used as selective adsorbent for the extraction of lead ions from aqueous medium. Single variant experiments were carried out for all optimizations of sorption/desorption steps including pH of solution, amount of nanoparticles, mixing type/period and eluent type. An SQT with five round slots was placed onto the burner of FAAS to increase the interaction between lead atoms and light from radiation source to enhance the absorbance signals. Under the determined optimum conditions, analytical figures of merit were evaluated and the limit of detection and quantification (LOD/LOQ) values were calculated as 5.2 and 17.3 µg L − 1 , respectively. The developed method showed a linear calibration range between 25 and 250 µg L − 1 with a good regression coefficient value (0.9995). Recovery studies were also performed with domestic wastewater samples spiked at three concentrations and percent recovery values obtained in the range of 97%-102% validated the developed method's applicability and accuracy.