Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study

Cook, Deborah J.; Guyatt, Gordon; Rocker, Graeme; Sjökvist, Peter; Weaver, Bruce; Dodek, Peter; Marshall, John C.; Leasa, David; Levy, Mitchell M.; Varon, Joseph; Fisher, Murray; Cook, Richard

doi:10.1016/s0140-6736(01)06960-4

Cited by 113 publications

(52 citation statements)

References 29 publications

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“…Women were more or laboratory perturbation, which explain a portion of acute illness severity. Differences in severity of illness across age groups at the time of withdrawal would suggest that a combination of age and acute severity of illness were factored into the decision to withdraw mechanical ventilation, a fi nding that we 16 and others 33,34 have described previously but that has not been consistently confi rmed. 3 Providers may be more willing to withdraw mechanical ventilation earlier in older patients who have poor long-term prognosis with less attention to their short-term severity of illness; on the other hand, uncertainty in the long-term prognosis for younger patients may delay withdrawal until outcome of death is more certain and immediate.…”

Section: Discussionmentioning

confidence: 76%

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Cooke

Hotchkin

Engelberg

et al. 2010

Chest

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A pproximately 20% of all American patients die during or shortly after a stay in the ICU, 1 the majority of whom do so in the context of a decision to forego life-sustaining therapy. [2][3][4] Once families and caregivers decide to withdraw life support, experts in end-of-life communication advocate for clinicians to inform families of what they should expect during their loved one's dying process. 5,6 This communication might include details about the expected myoclonus of dying patients, the potential for agonal respirations after discontinuation of mechanical ventilation, and the timing of death after withdrawal of life support. 6 Despite frequent family requests as well as expert recommendations for discussion of the postwithdrawal course, few data exist to guide clinicians in accurately conveying the anticipated course. [7][8][9] The majority of studies that examine the timing of death after withdrawal focus on patients with severe neurologic injury in the context of organ donation after cardiac death 10 or on whether the use of analgesics and sedatives during the dying process hasten death in patients who are critically ill. 7,11 These studies, among others, 12,13 dedicate little attention to other factors that may infl uence the timing of death after withdrawal of life support, such as age, severity of illness, or underlying diagnosis. Characterization of the factors that predict time to death may inform familycaregiver communication at the end of life and alleviate some of the anxiety and frustration resulting

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Section: Discussionmentioning

confidence: 76%

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Cooke

Hotchkin

Engelberg

et al. 2010

Chest

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“…45 Only 11% of patients had explicit CPR directives established within the first 24 hr. Residents in the ICU established the largest proportion of the directives and significantly more directives were established at night and at weekends.…”

Section: Establishing Cardiopulmonary Resuscitation Directivesmentioning

confidence: 99%

Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

Rocker

Cook

Shemie

2006

Can J Anesth/J Can Anesth

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“…In university affiliated ICUs participating in the level of care study, we found that half of the CPR directives established in the first 24 hr of ICU admission were established by residents, and affirmed by attending physicians. 28 This may reflect the fact that in teaching institutions, residents are more often in the hospital than attending physicians. The apprenticeship model of learning underscores that we have much to achieve in practice and medical education to improve future end-of-life care.…”

Section: ) Educate Future Cliniciansmentioning

confidence: 99%

Dying in the ICU: strategies that may improve end-of-life care

Cook

Rocker

Heyland

2004

Can J Anesth/J Can Anesth

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P Pu ur rp po os se e: : Since 10 to 20% of adult patients admitted to the intensive care unit (ICU) in Canada die, addressing the needs of dying critically ill patients is of paramount importance. The purpose of this article is to suggest some strategies to consider to improve the care of patients dying in the ICU.S So ou ur rc ce e: : Data sources were randomized clinical trials, observational studies and surveys. We purposively selected key articles on endof-life care to highlight eight initiatives that have the potential to improve care for dying critically ill patients. These initiatives were presented at the International Consensus Conference on End-ofLife Care in the ICU on April 24-25, 2003 in Brussels, Belgium.P Pr ri in nc ci ip pa al l f fi in nd di in ng gs s: : We describe eight strategies that, if adopted, may positively impact on the end-of-life care of critically ill patients: 1) promote social change through professional initiatives; 2) legitimize research in end-of-life care; 3) determine what dying patients need; 4) determine what families of dying patients need; 5) initiate quality improvement locally; 6) use quality tools with care; 7) educate future clinicians; and 8) personally engage in end-of-life care. Most of these strategies have not been subjected to rigorous evaluation.C Co on nc cl lu us si io on n: : Adoption of some of these strategies we describe may lead to improved end-of-life care in the ICU. Future studies should include more formal evaluation of the efficacy of end-of-life interventions to help us ensure high quality, clinically relevant, culturally adapted care for all dying critically ill patients. Objectif : Au Canada, comme 10 à 20 % des patients admis à l'unité des soins intensifs (USI) y décèdent, il devient primordial de s'occuper des besoins des grands malades en fin de vie. Le but du présent article est de proposer certaines stratégies pour améliorer les soins de ceux qui meurent à l'USI. Source : Les données proviennent d'essais cliniques randomisés, d'é-tudes observationnelles et d'enquêtes. Nous avons volontairement choisi des articles clés sur les soins aux mourants pour mettre en lumière huit initiatives qui peuvent améliorer la condition des grands malades mourants. Ces initiatives ont été présentées à l'International Consensus Conference on End-of-Life Care in the ICU le 24 avril 2003 à Bruxelles en Belgique. Constatations principales : Nous décrivons huit stratégies qui, si elles sont adoptées, pourraient avoir un impact positif sur les soins aux mourants : 1) promouvoir un changement social par des initiatives professionnelles ; 2) légitimer la recherche sur les soins aux mourants ; 3) déterminer les besoins des mourants ; 4) déterminer les besoins des familles des mourants ; 5) commencer par améliorer la qualité localement ; 6) utiliser les outils de qualité avec précaution ; 7) former les futurs cliniciens et 8) s'engager personnellement dans les soins de fin de vie. La majorité de ces stratégies n'a pas fait l'objet d'évaluation rigoureuse. Conclusion ...

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Cardiopulmonary resuscitation directives on admission to intensive-care unit: an international observational study

Cited by 113 publications

References 29 publications

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

Dying in the ICU: strategies that may improve end-of-life care

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