Withholding and withdrawal of therapy in patients with acute renal injury: a retrospective cohort study.
The incidence of withholding and withdrawal of therapy in the setting of multi-organ failure in critically ill patients has increased. Epidemiological data on the decision-making process of withholding or withdrawal of therapy from Australian and New Zealand intensive care units is sparse. We examined the clinical and electronic records of 179 consecutive patients, admitted to the ICU between 1st January 2000 and 31st December 2001, who had acute renal injury. Acute renal replacement therapy was offered in 11.2% of patients. Therapy was withheld or withdrawn in 21.2% of patients. The levels of supportive care were comparable between those who had therapy withheld or withdrawn and those who had full intensive care therapy until such a decision was made. Predicted mortality (OR 1.04, 95% CI: 1.01-1.08, P = 0.03) and age (OR 1.04, 95% CI: 1.00-1.08, P = 0.03) were independently associated with the decision to withhold or withdraw therapy. The mean ICU stay of those with withdrawal or withholding of therapy was much shorter than those with full therapy (2.5 vs 5.7 days). This was likely to be due to an older age of our cohort, rapid progressive nature of the acute disease, a different clinical approach to treating critically ill elderly patients, or a combination of these factors. This pattern of practice was quite different from those reported from ICUs in other parts of the world. A prospective multi-centre observational study will clarify the pattern of practice in this important area of intensive care practice in Australasia.
Department of Anaesthesia and Intensive Care, North Shore Hospital, Takapuna, Auckland 1309, New Zealand.
K M
KM
Ho
J
J
Liang
T
T
Hughes
K
K
O'Connor
D
D
Faulke
D058186:Acute Kidney Injury / Q000503:physiopathology / Q000628:therapy*; D000368:Aged; D000704:Analysis of Variance; D001315:Australia; D015331:Cohort Studies; D016638:Critical Illness; D003657:Decision Making; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D028761:Withholding Treatment / Q000706:statistics & numerical data*