title: Withholding and withdrawing life-sustaining therapy in a Canadian intensive care unit.
abstract: The purpose of this study was to document the rationale and procedures for withholding and withdrawing life-sustaining treatment in critically ill patients. A prospective observational study was conducted over 12 mo in a Canadian academic intensive care unit. Of the 110 intensive care unit patients who died during the study period, 71 (64.5%) died after treatment was withheld or withdrawn. Compared with the other 39 patients who died despite full therapy, these patients were found to have a longer hospital and ICU stay, more organ systems failed, and a higher rate of malignancy. Intensivists rated poor prognosis for survival and poor quality of life should the patient survive as being the two most important factors when making a decision to withhold or withdraw treatment, while patient age and physical health prior to hospital admission were the two least important factors. There was a consistent approach to withdrawing therapy in 68 of the 71 patients who had treatment either withheld or withdrawn. In these 68 patients, the first step was to write a do-not-resuscitate order, vasopressor drugs were then stopped and, lastly, the patient was weaned from mechanical ventilation and the trachea was extubated. The results of this study demonstrate that life-supporting treatment is commonly withdrawn in critically ill patients when continued therapy is thought to be unlikely to restore the patient to health.
authors.affiliation: Department of Anaesthesia, Queen's University, Kingston, Ontario, Canada.
authors.forename: G G
authors.initials: GG
authors.lastname: Wood
authors.forename: E
authors.initials: E
authors.lastname: Martin
mesh_terms: D000367:Age Factors; D000368:Aged; D002170:Canada / Q000453:epidemiology; D003422:Critical Care / Q000706:statistics & numerical data; D016638:Critical Illness; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure; D009369:Neoplasms; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D012121:Respiration, Artificial; D016414:Resuscitation Orders; D015996:Survival Rate; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D028761:Withholding Treatment
chemical_list: D014662:Vasoconstrictor Agents