title: Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.
abstract: BACKGROUND
  Most deaths in the intensive care unit (ICU) involve withholding or withdrawing multiple life-sustaining therapies, but little is known about how to proceed practically and how this process affects family satisfaction.
  
  
  OBJECTIVE
  To examine the duration of life-support withdrawal and its association with overall family satisfaction with care in the ICU.
  
  
  METHODS
  We studied family members of 584 patients who died in an ICU at 1 of 14 hospitals after withdrawal of life support and for whom complete medical chart and family questionnaires were available.
  
  
  RESULTS
  Data concerning six life-sustaining interventions administered during the last 5 days of life were collected. Families were asked to rate their satisfaction with care using the Family Satisfaction in the ICU questionnaire. For nearly half of the patients (271/584), withdrawal of all life-sustaining interventions took more than 1 day. Patients with a prolonged (>1 d) life-support withdrawal were younger, stayed longer in the ICU, had more life-sustaining interventions, had less often a diagnosis of cancer, and had more decision makers involved. Among patients with longer ICU stays, a longer duration in life-support withdrawal was associated with an increase in family satisfaction with care (P = 0.037). Extubation before death was associated with higher family satisfaction with care (P = 0.009).
  
  
  CONCLUSIONS
  Withdrawal of life support is a complex process that depends on patient and family characteristics. Stuttering withdrawal is a frequent phenomenon that seems to be associated with family satisfaction. Extubation before death should be encouraged if possible.
authors.affiliation: Departments of Internal Medicine and Critical Care, Geneva University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.
authors.forename: Eric
authors.initials: E
authors.lastname: Gerstel
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Engelberg
authors.forename: Thomas
authors.initials: T
authors.lastname: Koepsell
authors.forename: J Randall
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics*; D008020:Life Support Care / Q000379:methods / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D011368:Professional-Family Relations / Q000941:ethics*; D011795:Surveys and Questionnaires; D028761:Withholding Treatment