Withdrawing care. Experience in a medical intensive care unit.
OBJECTIVE
To describe the process and outcomes of withdrawing life-sustaining interventions in a medical intensive care unit (MICU).


METHODS
Retrospective case series.


METHODS
Medical intensive care unit in a community teaching hospital.


METHODS
Consecutive series of 28 patients in whom mechanical ventilation, dialysis, and/or vasopressors were withdrawn. We distinguished physiological, neurological, and functional rationales for care withdrawal.


METHODS
Duration of discussions, MICU length of stay, and hospital survival.


RESULTS
Mean +/- SD Acute Physiology and Chronic Health Evaluation (APACHE II) score was 27.1 +/- 7.3 on MICU admission, and average +/- SD predicted hospital mortality was 61% +/- 22%. Discussions leading to withdrawal of care occurred over an average +/- SD of 5.2 +/- 5.5 days, with decisions achieved soonest in cases with poor neurological prognosis. Average +/- SD MICU length of stay was 1.4 +/- 1.8 days following a decision to withdraw MICU care, and only four patients received more than 48 hours of additional MICU care. Four patients were discharged alive from the hospital.


CONCLUSIONS
Patients and their surrogates willingly considered outcomes in addition to mortality when considering withdrawal of life-sustaining interventions. Finding an accommodation between physician judgments and patient preferences took time and effort but was an effective means of limiting ineffective life-sustaining efforts. Withdrawing futile or unwanted care was not always fatal.
Lee
D K
DK
Rochester General Hospital, NY 14621.
Swinburne
A J
AJ
Fedullo
A J
AJ
Wahl
G W
GW
D003657:Decision Making; D005066:Euthanasia, Passive / Q000523:psychology; D017052:Hospital Mortality; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units / Q000592:standards; D007902:Length of Stay; D008020:Life Support Care; D009518:New York; D010043:Outcome and Process Assessment, Health Care; D010358:Patient Participation; D016414:Resuscitation Orders; D012189:Retrospective Studies; D018570:Risk Assessment; D013727:Terminal Care; D028761:Withholding Treatment