Clinician discomfort with life support plans for mechanically ventilated patients.
OBJECTIVE
To examine the incidence and predictors of clinician discomfort with life support plans for ICU patients.


METHODS
Prospective cohort in 13 medical-surgical ICUs in four countries.


METHODS
657 mechanically ventilated adults expected to stay in ICU at least 72 h.


RESULTS
Daily we documented the life support plan for mechanical ventilation, inotropes and dialysis, and clinician comfort with these plans. If uncomfortable, clinicians stated whether the plan was too technologically intense (the provision of too many life support modalities or the provision of any modality for too long) or not intense enough, and why. At least one clinician was uncomfortable at least once for 283 (43.1%) patients, primarily because plans were too technologically intense rather than not intense enough (93.9% vs. 6.1%). Predictors of discomfort because plans were too intense were: patient age, medical admission, APACHE II score, poor prior functional status, organ dysfunction, dialysis in ICU, plan to withhold dialysis, plan to withhold mechanical ventilation, first week in the ICU, clinician, and city.


CONCLUSIONS
Clinician discomfort with life support perceived as too technologically intense is common, experienced mostly by nurses, variable across centers, and is more likely for older, severely ill medical patients, those with acute renal failure, and patients lacking plans to forgo reintubation and ventilation. Acknowledging the sources of discomfort could improve communication and decision making.
Griffith
Lauren
L
Department of Clinical Epidemiology, Medical Center, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. griffith@mcmaster.ca
Cook
Deborah
D
Hanna
Steven
S
Rocker
Graeme
G
Sjokvist
Peter
P
Dodek
Peter
P
Marshall
John
J
Levy
Mitchell
M
Varon
Joseph
J
Finfer
Simon
S
Jaeschke
Roman
R
Buckingham
Lisa
L
Guyatt
Gordon
G
D018806:APACHE; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003422:Critical Care; D005260:Female; D006801:Humans; D007297:Inpatients; D007362:Intensive Care Units; D008020:Life Support Care; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012121:Respiration, Artificial / Q000451:nursing*; D013997:Time Factors