Journal ArticleDOI
Determinants in Canadian health care workers of the decision to withdraw life support from the critically ill. Canadian Critical Care Trials Group
Deborah J. Cook,G. H. Guyatt,Roman Jaeschke,J Reeve,A Spanier,Derek King,David William Molloy,Andrew R. Willan,David L. Streiner +8 more
TLDR
While ICU health care workers consistently identify a number of patient factors as important in decisions to withdraw care, there is extreme variability, which may be explained in part by the values of individual health care providers.Abstract:
OBJECTIVE To examine the attitudes of health care workers regarding the withdrawal of life support. DESIGN Cross-sectional survey. PARTICIPANTS Attending staff, house staff, and intensive care unit (ICU) nurses in 37 Canadian university-affiliated hospitals. MAIN OUTCOME MEASURES Health care workers' ratings of the importance of 17 factors considered in the decision to withdraw life support, and their ratings of five levels of care ranging from comfort measures to intensive care in two of 12 different clinical scenarios. RESULTS We surveyed 1361 respondents (149 of 167 potentially eligible ICU attending staff, 142 of 173 ICU house staff, and 1070 of 1455 ICU nurses, with response rates of 89%, 82% and 74%, respectively). The most important factors were likelihood of surviving the current episode, likelihood of long-term survival, premorbid cognitive function, and age of the patient. In choosing the level of care for the patient scenarios, the same option was chosen by more than 50% of respondents in only one of 12 scenarios; opposite extremes of care were chosen by more than 10% of the respondents in eight of 12 scenarios. Respondent characteristics affecting choices included the number of years since graduation, the city and province in which they worked, the number of beds in their ICU, and their assessment of the likelihood that they would withdraw life support in comparison with their colleagues (P < .001 for all comparisons). CONCLUSIONS While ICU health care workers consistently identify a number of patient factors as important in decisions to withdraw care, there is extreme variability, which may be explained in part by the values of individual health care providers.read more
Citations
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Journal ArticleDOI
Withholding and withdrawal of life support in intensive-care units in France: a prospective survey
TL;DR: Withholding and withdrawal of life-support therapies are widely practised in French ICUs, despite their prohibition by the French legislation, which may explain several limitations on the various steps of the decision-making process.
Journal ArticleDOI
Recommendations for end-of-life care in the intensive care unit: The Ethics Committee of the Society of Critical Care Medicine.
Robert D. Truog,Alexandra F. M. Cist,Sharon Brackett,Jeffrey P. Burns,Martha A. Q. Curley,Marion Danis,Michael A. DeVita,Stanley H. Rosenbaum,David Rothenberg,Charles L. Sprung,Sally A. Webb,Ginger Schafer Wlody,William E. Hurford +12 more
TL;DR: These recommendations are written from the emerging perspective that palliative care and intensive care are not mutually exclusive options but rather should be coexistent.
Journal ArticleDOI
An Official ATS/AACN/ACCP/ESICM/SCCM Policy Statement: Responding to Requests for Potentially Inappropriate Treatments in Intensive Care Units.
Gabriel T. Bosslet,Thaddeus Mason Pope,Gordon D. Rubenfeld,Bernard Lo,Robert D. Truog,Cynda Hylton Rushton,J. Randall Curtis,Dee W. Ford,Molly L. Osborne,Cheryl Misak,David H. Au,Elie Azoulay,Baruch A. Brody,Brenda G. Fahy,Jesse B. Hall,Jozef Kesecioglu,Alexander A. Kon,Kathleen O. Lindell,Douglas B. White +18 more
TL;DR: The multisociety statement on responding to requests for potentially inappropriate treatments in intensive care units provides guidance for clinicians to prevent and manage disputes in patients with advanced critical illness.
Journal ArticleDOI
Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit.
Deborah J. Cook,Graeme Rocker,John C. Marshall,Peter Sjokvist,Peter Dodek,Lauren Griffith,Andreas Freitag,Joseph Varon,Christine A. Bradley,Mitchell M. Levy,Simon Finfer,Cindy Hamielec,Joseph McMullin,Bruce Weaver,Stephen D. Walter,Gordon H. Guyatt +15 more
TL;DR: The strongest determinants of the withdrawal of ventilation in critically ill patients were the physician's perception that the patient preferred not to use life support, the physicians' predictions of a low likelihood of survival in the intensive care unit and a high likelihood of poor cognitive function, and the use of inotropes or vasopressors.
Journal ArticleDOI
Ethics and end-of-life care for adults in the intensive care unit
TL;DR: High-quality decision making and end-of-life care are essential in all regions, and can improve patient and family outcomes, and also retention of clinicians working in the ICU.