title: Decisions to withhold or withdraw life-sustaining treatment in a Norwegian intensive care unit.
abstract: BACKGROUND
  To withhold and withdraw treatment are important and difficult decisions made in the intensive care unit (ICU). The aim of this study was to investigate the incidence of withholding or withdrawing treatment, characteristics of the patients, and how these decision processes were handled and documented in a general ICU from 2007 to 2009 in a university hospital in Norway.
  
  
  METHODS
  Patient characteristics and outcomes of treatment were prospectively registered. We retrospectively reviewed the medical records for information on limitations in treatment.
  
  
  RESULTS
  In total, 1287 patients were admitted to the ICU. The ICU mortality was 208 (16%), and the hospital mortality was 341 (26%). In total, 301 patients (23%) had treatment withheld or withdrawn. Medical and unscheduled surgical patients with limitations in treatment had higher Simplified Acute Physiology Score II (P < 0.001) and were older (P < 0.001) than those without limitations in treatment. The most common main reason for withdrawing treatment was poor prognosis. According to the medical records, the patient was involved in the decision-making regarding withdrawal of treatment in only 2% of the cases, and the patient's relatives were involved in the decision-making in 77% of the cases. In 12% of the cases, type of treatment withdrawn was not documented.
  
  
  CONCLUSIONS
  Withholding or withdrawing treatment in the ICU was common. Medical and unscheduled surgical patients with limitations in treatment were older and more severely ill than patients without limitations. There is a potential for better documentation of the processes regarding withholding or withdrawing life-sustaining intensive care treatment.
authors.affiliation: Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
authors.forename: H
authors.initials: H
authors.lastname: Hoel
authors.forename: S A
authors.initials: SA
authors.lastname: Skjaker
authors.forename: R
authors.initials: R
authors.lastname: Haagensen
authors.forename: K
authors.initials: K
authors.lastname: Stavem
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care / Q000941:ethics*; D004282:Documentation; D005260:Female; D017052:Hospital Mortality; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics*; D008020:Life Support Care / Q000941:ethics*; D008297:Male; D008875:Middle Aged; D009664:Norway; D012017:Referral and Consultation; D016414:Resuscitation Orders / Q000941:ethics*; D012189:Retrospective Studies; D016896:Treatment Outcome; D028761:Withholding Treatment / Q000941:ethics*