title: Limiting intensive care therapy in dying critically Ill patients: Experience from a tertiary care center in United Arab Emirates.
abstract: BACKGROUND
  Limitations of life-support interventions, by either withholding or withdrawing support, are integrated parts of intensive care unit (ICU) activities and are ethically acceptable. The end-of-life legal aspects and practices in United Arab Emirates ICUs are rarely mentioned in the medical literature. The objective of this study was to examine the current practice of limiting futile life-sustaining therapies in our ICU, modalities for implementing of these decisions, and documentations in dying critically ill patients.
  
  
  METHODS
  This was a retrospective observational study conducted at our ICU. We studied all ICU patients who died from September 2008 to February 2009. Patients' baseline demo-graphics, past medical problems, diagnosis on admission to ICU, and decision to withhold, withdraw and their modalities were collected.
  
  
  METHODS
  This was a retrospective observational study conducted at our ICU. We studied all ICU patients who died from September 2008 to February 2009. Patients' baseline demo-graphics, past medical problems, diagnosis on admission to ICU, and decision to withhold, withdraw and their modalities were collected.
  
  
  RESULTS
  The electronic medical records of 67 patients were reviewed. The commonest method of limiting therapy was no escalation 53.6%. Interventions were withheld in 41.5%. "Do not resuscitate" order was documented in only 16.3%. The commonest method of documenting limitation of therapy was discussion with the family and documenting the prognosis and futility of additional therapy (73.3%). Patients who died early (<48 hrs) compared to patients who died late (>48 hrs) of ICU admission received terminal cardiopulmonary resuscitation more frequently (P < 0.007), had less frequent prognosis documentation (P < 0.009), and had more vasopressors administered (P < 0.006).
  
  
  CONCLUSIONS
  Withholding therapy after discussion with the family was the preferred mode of limiting therapy in a dying patient.
authors.affiliation: Department of Critical Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
authors.forename: Ur Rahman
authors.initials: UR
authors.lastname: Masood
authors.affiliation: Department of Critical Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
authors.forename: Abuhasna
authors.initials: A
authors.lastname: Said
authors.affiliation: Department of Neonatal Intensive Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
authors.forename: Chedid
authors.initials: C
authors.lastname: Faris
authors.affiliation: Department of Critical Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
authors.forename: Mousab
authors.initials: M
authors.lastname: Al Mussady
authors.affiliation: Department of Pharmacy, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
authors.forename: Amer
authors.initials: A
authors.lastname: Al Jundi
keywords: Intensive care unit; life-sustaining treatment; withdrawal; withholding