P Pu ur rp po os se e: : Most deaths in intensive care units (ICUs) follow a withdrawal of life support (LS). Evaluation of this process including the related perspectives of grieving family members is integral to improvement of palliation in the ICU.M Me et th ho od ds s: : A prospective, multicentre, cohort study in six Canadian university-affiliated ICUs included 206 ICU patients (length of stay $ 48 hr) who received mechanical ventilation (MV) before LS withdrawal. We recorded modes, sequence and time course of LS withdrawal and drug usage (4 hr before; 4-8 hr and 8-12 hr before death). We asked a specified family member to assess patient comfort and key aspects of end-of life care. These doses did not differ among the three time periods before death. Of 196 responses from family members most indicated that patients were perceived to be either totally (73, 37.2%), very (48, 24.5%), or mostly comfortable (58, 29.6%). Times to death, morphine use and family members' perceptions of comfort were similar for each type of change to MV. C Co on nc cl lu us si io on ns s: : Most patients were perceived by family members to die in comfort during a withdrawal of LS. Perceptions of patient comfort and drug use in the hours before death were not associated with the mode or sequence of withdrawal of LS, or the time to death.
Objectif : La plupart des décès qui surviennent dans les unités de soins intensifs (USI) suivent le retrait du maintien de la survie (MS). L'évaluation de cette situation, y compris les perspectives reliées à la peine des membres de la famille, est indispensable pour améliorer les soins palliatifs à l'USI.
Méthode : Une étude de cohorte prospective multicentrique de six USI canadiennes d'affiliation universitaire comportait 206 patients de l'USI (séjour de = 48 h) qui ont reçu une ventilation mécanique (VM) avant le retrait du MS. Nous avons noté les modes de retrait du MS, leur séquence et leur évolution et l'usage de médicaments (4 h avant ; 4-8 h et 8-12 h avant la mort). Nous avons demandé à un membre de la famille en particulier d'évaluer le confort du patient et les aspects clés des soins palliatifs.Résultats : La VM a été retirée pour 155/206 (75,2 %) patients ; 97/155 (62,6 %)