title: Clinician discomfort with life support plans for mechanically ventilated patients.
abstract: 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.
authors.affiliation: Department of Clinical Epidemiology, Medical Center, McMaster University, 1200 Main Street West, Hamilton, Ontario, L8N 3Z5, Canada. griffith@mcmaster.ca
authors.forename: Lauren
authors.initials: L
authors.lastname: Griffith
authors.forename: Deborah
authors.initials: D
authors.lastname: Cook
authors.forename: Steven
authors.initials: S
authors.lastname: Hanna
authors.forename: Graeme
authors.initials: G
authors.lastname: Rocker
authors.forename: Peter
authors.initials: P
authors.lastname: Sjokvist
authors.forename: Peter
authors.initials: P
authors.lastname: Dodek
authors.forename: John
authors.initials: J
authors.lastname: Marshall
authors.forename: Mitchell
authors.initials: M
authors.lastname: Levy
authors.forename: Joseph
authors.initials: J
authors.lastname: Varon
authors.forename: Simon
authors.initials: S
authors.lastname: Finfer
authors.forename: Roman
authors.initials: R
authors.lastname: Jaeschke
authors.forename: Lisa
authors.initials: L
authors.lastname: Buckingham
authors.forename: Gordon
authors.initials: G
authors.lastname: Guyatt
mesh_terms: 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