Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury.
OBJECTIVE
To review end of life care issues in the intensive care unit (ICU) and how practice variation might affect the ultimate outcome of acute brain injury.


METHODS
Bibliographic literature search and personal files.


RESULTS
In Canada, 10-20% of critically ill adults die in the ICU. Many of these deaths follow acute brain injury in the setting of clinical deterioration, life support limitation and brain death. This brief review addresses some key elements of end of life care for critically ill brain injured patients, including family interactions, making survival predictions, and factors influencing decision-making about cardiopulmonary resuscitation and withdrawal of mechanical ventilation.


CONCLUSIONS
Provision of compassionate high quality end of life care should be standard of practice for brain injured and all other critically ill patients who cannot survive. Inconsistencies in end of life care may affect where, when and how patients die, the quality of their death and whether or not they are considered for organ and tissue donation.
Rocker
Graeme M
GM
Department of Medicine, Dalhousie University, Halifax, Nova Scotia B3H 3A7, Canada. gmrocker@dal.ca
Cook
Deborah J
DJ
Shemie
Sam D
SD
D001926:Brain Death; D001930:Brain Injuries / Q000628:therapy*; D002170:Canada; D003422:Critical Care; D016638:Critical Illness; D006801:Humans; D007362:Intensive Care Units; D010818:Practice Patterns, Physicians'; D013727:Terminal Care; D028761:Withholding Treatment