title: Variations in the Operational Process of Withdrawal of Life-Sustaining Therapy.
abstract: OBJECTIVE
  The process of withdrawal of life-sustaining therapy remains poorly described in the current literature despite its importance for patient comfort and optimal end-of-life care. We conducted a structured review of the published literature to summarize patterns of withdrawal of life-sustaining therapy processes in adult ICUs.
  
  
  METHODS
  Electronic journal databases were searched from date of first issue until April 2014.
  
  
  METHODS
  Original research articles describing processes of life-support therapy withdrawal in North American, European, and Australian ICUs were included.
  
  
  METHODS
  From each article, we extracted definitions of withdrawal of life-sustaining therapy, descriptions and order of interventions withdrawn, drugs administered, and timing from withdrawal of life-sustaining therapy until death.
  
  
  RESULTS
  Fifteen articles met inclusion criteria. Definitions of withdrawal of life-sustaining therapy varied and focused on withdrawal of mechanical ventilation; two studies did not present operational definitions. All studies described different aspects of process of life-support therapy withdrawal and measured different time periods prior to death. Staggered patterns of withdrawal of life-support therapy were reported in all studies describing order of interventions withdrawn, with vasoactive drugs withdrawn first followed by gradual withdrawal of mechanical ventilation. Processes of withdrawal of life-sustaining therapy did not seem to influence time to death.
  
  
  CONCLUSIONS
  Further description of the operational processes of life-sustaining therapy withdrawal in a more structured manner with standardized definitions and regular inclusion of measures of patient comfort and family satisfaction with care is needed to identify which patterns and processes are associated with greatest perceived patient comfort and family satisfaction with care.
authors.affiliation: 1Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada. 2Bertram Loeb Research Consortium in Organ and Tissue Donation, University of Ottawa, Ottawa, ON, Canada. 3Children's Hospital of Eastern Ontario Research Institute, Ottawa, ON, Canada. 4Ottawa Hospital Research Institute Methods Center, Ottawa, ON, Canada. 5Division of Pediatric Critical Care, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada.
authors.forename: Amanda
authors.initials: A
authors.lastname: van Beinum
authors.forename: Laura
authors.initials: L
authors.lastname: Hornby
authors.forename: Roxanne
authors.initials: R
authors.lastname: Ward
authors.forename: Tim
authors.initials: T
authors.lastname: Ramsay
authors.forename: Sonny
authors.initials: S
authors.lastname: Dhanani
mesh_terms: D006801:Humans; D013727:Terminal Care; D028761:Withholding Treatment / Q000592:standards*