Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study

Turgeon, Alexis F.; Lauzier, François; Simard, J. Marc; Scales, Damon C.; Burns, Karen E. A.; Moore, Lynne; Zygun, David; Bernard, Francis; Meade, Maureen O.; Dung, Tran Cong; Ratnapalan, Mohana; Todd, Stephanie; Harlock, John; Fergusson, Dean

doi:10.1503/cmaj.101786

Cited by 355 publications

(297 citation statements)

References 25 publications

(13 reference statements)

Supporting

Mentioning

277

Contrasting

Unclassified

Order By: Relevance

“…58,59 Opinions concerning the prognosis of neurocritical care patients vary among critical care practitioners. This variability may lead to significant differences in withdrawal-of-care practices, [60][61][62][63][64] which in turn may explain some of the marked variability in outcomes that has been described, even within Canada. 54,60 Some research has suggested that physicians may be generally more pessimistic about the prognosis of neurocritical care patients than is justified by their particular clinical characteristics.…”

Section: Discussionmentioning

confidence: 99%

“…This variability may lead to significant differences in withdrawal-of-care practices, [60][61][62][63][64] which in turn may explain some of the marked variability in outcomes that has been described, even within Canada. 54,60 Some research has suggested that physicians may be generally more pessimistic about the prognosis of neurocritical care patients than is justified by their particular clinical characteristics. 65 We found that the length of ICU stay among hospital survivors has increased over time, possibly indicating that local critical care physicians are delaying decisions related to withdrawal of life-sustaining interventions more often than previously.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Kramer

Zygun

2013

Can J Anesth/J Can Anesth

Self Cite

View full text Add to dashboard Cite

“…1,2 Increased intracranial pressure, a frequent consequence of traumatic brain injury, is strongly associated with mortality in this patient population. 3 To control this increase in pressure, several interventions were proposed, including cerebrospinal fluid drainage, 4 barbiturate coma, 5 and decompressive craniectomy.…”

Section: Introductionmentioning

confidence: 99%

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Berger-Pelleiter

Émond

Lauzier

et al. 2016

CJEM

Self Cite

View full text Add to dashboard Cite

Objectives: Hypertonic saline solutions are increasingly used to treat increased intracranial pressure following severe traumatic brain injury. However, whether hypertonic saline provides superior management of intracranial pressure and improves outcome is unclear. We thus conducted a systematic review to evaluate the effect of hypertonic saline in patients with severe traumatic brain injury. Methods: Two researchers independently selected randomized controlled trials studying hypertonic saline in severe traumatic brain injury and collected data using a standardized abstraction form. No language restriction was applied. We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and BIOSIS databases. We searched grey literature via OpenGrey and National Technical Information Service databases. We searched the references of included studies and relevant reviews for additional studies.Results: Eleven studies (1,820 patients) were included. Hypertonic saline did not decrease mortality (risk ratio 0.96, 95% confidence interval [CI] 0.83 to 1.11, I 2 = 0%) or improve intracranial pressure control (weighted mean difference −1.25 mm Hg, 95% CI −4.18 to 1.68, I 2 = 78%) as compared to any other solutions. Only one study reported monitoring for adverse events with hypertonic saline, finding no significant differences between comparison groups. Conclusions: We observed no mortality benefit or effect on the control of intracranial pressure with the use of hypertonic saline when compared to other solutions. Based on the current level of evidence pertaining to mortality or control of intracranial pressure, hypertonic saline could thus not be recommended as a first-line agent for managing patients with severe traumatic brain injury. RÉSUMÉObjectifs: Les solutés salés hypertoniques sont de plus en plus utilisés dans le traitement de l'élévation de la pression intracrânienne par suite d'une lésion cérébrale traumatique grave. Toutefois, on ne sait pas avec certitude si les solutés salés hypertoniques sont plus efficaces que d'autres traitements dans l'abaissement de la pression intracrânienne et s'ils donnent de meilleurs résultats. Les auteurs ont donc entrepris une revue systématique de la documentation afin d'évaluer l'effet des solutés salés hypertoniques chez les patients ayant subi une lésion cérébrale traumatique grave. Méthode: Deux chercheurs ont sélectionné chacun de leur côté des essais comparatifs à répartition aléatoire portant sur l'utilisation du soluté salé hypertonique dans le traitement des lésions cérébrales traumatiques graves, et ont recueilli des données sur un formulaire normalisé de résumé analytique. Aucune restriction de langue n'a été appliquée. Des recherches ont été effectuées dans les bases de données Medline, Embase, Cochrane Central Register of Controlled Trials, Scopus, Web of Science et Biosis. Les auteurs ont également consulté la documentation parallèle en passant par les bases de données OpenGrey et National Technical Information Service. Enfi...

show abstract

“…Despite the uncertainty of prognostication soon after brain injury, a high proportion of deaths are related to early withdrawal of life-support. In a Canadian study, about one half of deaths that occurred following the withdrawal of treatment in patients with severe head injury occurred within the first three days [22]. Because it is the withdrawal of life support, rather than the brain injury itself, that often precipitates a patient's death, treatment withdrawal may lead to a self-fulfilling prophecy.…”

Section: Editorialmentioning

confidence: 99%

“…Consideration of organ donation following a decision to withdraw life-sustaining treatment ensures that the wishes of all dying patients to donate their organs after death are identified, respected and honoured. There is considerable variability in current practice for withholding and withdrawing life-sustaining treatment after acute brain injury, reflecting different interpretations of outcome assessments as well as national, unit and personal biases [22]. High-quality research is needed to enable treatment-limiting decisions to be made within clinically relevant timescales and guided by improved prediction of outcomes that are meaningful to patients.…”

Section: Editorialmentioning

confidence: 99%

Treatment withdrawal and acute brain injury: an integral part of care

Smith

2012

Anaesthesia

View full text Add to dashboard Cite

Mortality associated with withdrawal of life-sustaining therapy for patients with severe traumatic brain injury: a Canadian multicentre cohort study

Cited by 355 publications

References 25 publications

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Declining mortality in neurocritical care patients: a cohort study in Southern Alberta over eleven years

Hypertonic saline in severe traumatic brain injury: a systematic review and meta-analysis of randomized controlled trials

Treatment withdrawal and acute brain injury: an integral part of care

Contact Info

Product

Resources

About