Withdrawal of Life-Sustaining Treatment in a Mixed Intensive Care Unit: Most Common in Patients with Catastropic Brain Injury

Verkade, Martijn A.; Epker, Jelle L.; Nieuwenhoff, Mariska D.; Bakker, Jan; Kompanje, Erwin J. O.

doi:10.1007/s12028-011-9567-y

Cited by 36 publications

(26 citation statements)

References 30 publications

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“…EoL practices in neurological and/or neurosurgical intensive care units (NICU) have been studied by other authors [30–32]. Two different single-center studies in NICU found TLDs in 4% and 14% of cases [30, 31].…”

Section: Discussionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundTreatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting.MethodsA retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs.ResultsTLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59 cases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding of neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD was made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent (20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients. The median time from the decision to death was 2 days (range 1–652). TLDs were documented in 93% of in-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD group cases. Family interaction and multi-team discussions were documented in >88% of cases, but no advanced directives were found, and notifications of patients’ preferences were found in only 7% of cases.DiscussionClinicians should consider limiting treatment if continued treatment is not in the patients best interest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.ConclusionTLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context need to be further explored.

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Section: Discussionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…Overly pessimistic prognostication and difficulty predicting patient adaptation could lead to an inappropriate increase in withdrawal of life-sustaining therapy in the neuroICU [15][16][17]. Since the majority of patients with severe neurologic injury who die in the ICU do so in the setting of withdrawal of mechanical ventilation, this is an important area for future study [13,14,18]. Although palliative care consultation triggers could expedite and improve the integration of palliative care into the neuroICU, the most efficient and patient-centered model of providing palliative care is not clear.…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units

et al. 2015

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Among neuroICU patients, 15.8 % met triggers for palliative care consultation. Although prevalence of admissions meeting any trigger was similar amongst all ICUs, neuroICU admissions met different types of triggers and were more likely to have withdrawal of life-sustaining therapy. These data suggest that palliative care needs are common among neuroICU patients and discussions with patients and families regarding limitation of life-sustaining therapy may differ in this setting.

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“…One potential explanation is that prognostic indices based on several factors in combination may predict outcome with better accuracy in neuro-critical care than in other areas in medicine (54)(55)(56)(57)(58). For patients with congestive heart failure, obstructive bronchitis, cirrhosis, kidney disease or cancer, it is rarely possible to prognosticate with certainty that a chronically ill subject will not survive an acute episode (59).…”

Section: Caregivers Have Equal Responsibility Towards Both the Dying mentioning

confidence: 99%

A few realistic questions raised by organ retrieval in the intensive care unit

Lesieur¹,

Genteuil²,

Leloup³

2017

Ann. Transl. Med.

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Organ transplantation saves the lives of many persons who would otherwise die from end-stage organ disease. The increasing demand for donated organs has led to a renewed interest in donation after circulatory determination of death (CDD). In many countries (including France), terminally ill patients who die of circulatory arrest after a planned withdrawal of life support may be considered as organ donors under certain conditions. While having equal responsibility towards the potential donor and the persons awaiting a transplant, caregivers may experience an ethical dilemma between the responsibility to deliver the best care to the dying, and the need to retrieve the organs. Once it has been established that the patient wishes to be a donor, we assume that end-of-life care and organ donation may have convergent goals when they contribute to transforming a comfortable death into a chance of life for others in need.

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Withdrawal of Life-Sustaining Treatment in a Mixed Intensive Care Unit: Most Common in Patients with Catastropic Brain Injury

Abstract: In 83, 7% of patients who die in the mixed ICU life-sustaining treatment is withdrawn. Severe cerebral damage was the leading reason to withdraw life-sustaining treatment.

Cited by 36 publications

References 30 publications

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Prevalence and Outcomes of Patients Meeting Palliative Care Consultation Triggers in Neurological Intensive Care Units

A few realistic questions raised by organ retrieval in the intensive care unit

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