title: End-of-life decisions in Burn Intensive Care Units - An International Survey.
abstract: BACKGROUND
  Burn victims and their families are faced with an unexpected, life changing injury, and they don't have the necessary time to adjust to the trauma. Even though there is extensive literature exploring the attitudes of intensive care physicians on forgoing life-sustaining treatment, little is known about end-of-life practices in specialised burn intensive care units (ICUs). The aim of this study was to evaluate physician beliefs, values, considerations and difficulties in end-of-life decisions in burn ICUs.
  
  
  METHODS
  Two hundred and fifty questionnaires were distributed via electronic mail to burn specialists, randomly selected from the directories of the 45(th) annual meeting of American Burn Association and the 15(th) European Burns Association Congresses.
  
  
  RESULTS
  A moral difference between withdrawing and withholding was stated by 73% of physicians, with withholding being viewed as more preferable (42% vs 37%). Primary reasons given by physicians for the decision to withhold/withdraw the treatment were the patient's medical condition/high probability of death (68%), unresponsiveness to therapy (68%), severity of burn (78%) and poor outcome in terms of quality of life (44%). Vasopressors (85%), blood products (68%) and renal replacement therapy (85%) were the common modalities withheld/withdrawn. Almost 50% involved the patients in the end-of-life decisions and 66% involved the family.
  
  
  CONCLUSIONS
  In this first international study on end-of-life attitudes, burn ICU physicians clearly distinguish between withhold and withdrawal decisions, with the majority preferring the former. In contrast to general ICUs, treatment limitation accounts only for the minority of the deaths.
authors.affiliation: Consultant in Critical Care and Major Trauma, Critical Care Units, King's College Hospital, London SE5 9RS, UK. Electronic address: victoria.metaxa@nhs.net.
authors.forename: Victoria
authors.initials: V
authors.lastname: Metaxa
authors.affiliation: Consultant in Critical Care Papanikolaou Hospital, Burn ICU, Thessaloniki, Greece. Electronic address: alavrenti@gmail.com.
authors.forename: Athina
authors.initials: A
authors.lastname: Lavrentieva
mesh_terms: D000328:Adult; D000776:Anesthesiology; D001291:Attitude of Health Personnel; D002053:Burn Units; D002056:Burns; D003422:Critical Care; D003657:Decision Making; D005260:Female; D013502:General Surgery; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008875:Middle Aged; D012067:Religion; D016414:Resuscitation Orders; D011795:Surveys and Questionnaires; D013727:Terminal Care; D028761:Withholding Treatment
keywords: Burns intensive care; End-of-life; Withhold/withdraw care