[Implementing limited therapy methods in intensive care units: discontinuing therapy, reducing therapy and withholding therapy in intensive care units of the Innsbruck University Clinics].
BACKGROUND
The intensive care physician is frequently confronted with the decision to withhold or withdraw therapy in patients with a poor prognosis. Apart from the legal implications, the practical management of withholding or withdrawing intensive care treatment continues to be indistinct. The subject has not been investigated in Austria or Germany. The aim of the study was to examine the different points of view of intensive care physicians and the various procedures to limit therapy in patients with a poor prognosis.


METHODS
We interviewed physicians working at different intensive care departments of the University Hospital of Innsbruck from March to April 1998.


RESULTS
Withholding treatment was given preference over withdrawing treatment. In regard of withdrawing treatment, 64% of the interviewed physicians felt more uncertain. In the decision making process the potential reversibility of disease was estimated to be more important than the wish of the patient. Hemofiltration and antibiotics were mentioned as the first measures the physicians would withdraw. The last measure that would be withheld was ventilatory support. Sixty-three per cent of the physicians felt that sedation and analgesia should be continued. In regard of withholding or withdrawing treatment 83% voted for an obligatory DNR order.


CONCLUSIONS
Before withholding or withdrawing intensive care therapy, a medical specialist must determine and document the futile prognosis of the patient. If the patient's wish is unknown, all further decisions should be made in agreement with all participants. The goal of the therapy is to provide the patient maximum comfort under minimal intensive care treatment.
Schobersberger
W
W
Klinische Abteilung für Allgemeine und Chirurgische Intensivmedizin, Universitätsklinik für Anästhesie und Intensivmedizin, Innsbruck. Wolfgang.Schobersberger@uibk.ac.at
Fries
D
D
Hasibeder
W
W
Schwamberger
H
H
Klingler
A
A
Antretter
V
V
Kofler
A
A
Hackl
J M
JM
D001291:Attitude of Health Personnel; D001317:Austria; D005066:Euthanasia, Passive; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008505:Medical Staff, Hospital; D016414:Resuscitation Orders