title: How is life support withdrawn in intensive care units: A narrative review.
abstract: Decisions to withdraw life-sustaining therapy (WDLS) are relatively common in intensive care units across Canada. As part of preliminary work to develop guidelines for WDLS, we performed a narrative review of the literature to identify published studies of WDLS.
  
  
  
  A search of MEDLINE and EMBASE databases was performed. The results were reviewed and only articles relevant to WDLS were included. Any references within these articles deemed to be relevant were subsequently included.
  
  
  
  The initial search identified 3687 articles. A total of 100 articles of interest were identified from the initial search and a review of their references. The articles were primarily composed of observational data and expert opinion. The information from the literature was organized into 6 themes: preparation for WDLS, monitoring parameters, pharmacologic symptom management, withdrawing life-sustaining therapies, withdrawal of mechanical ventilation, and bereavement.
  
  
  
  This review describes current practices and opinions about WDLS, and also demonstrates the significant practice variation that currently exists. We believe that the development of guidelines to help increase transparency and standardize the process will be an important step to ensuring high quality care during WDLS.
authors.affiliation: Rouge Valley Health System, Toronto, Canada.
authors.forename: Jesse W
authors.initials: JW
authors.lastname: Delaney
authors.affiliation: Division of Palliative Care, University of Toronto, Toronto, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Canada. Electronic address: james.downar@utoronto.ca.
authors.forename: James
authors.initials: J
authors.lastname: Downar
mesh_terms: D002170:Canada; D003422:Critical Care; D003657:Decision Making; D006801:Humans; D007362:Intensive Care Units; D008020:Life Support Care; D013727:Terminal Care; D028761:Withholding Treatment
keywords: Critical care; Life support care; Palliative care; Respiration, artificial; Terminal care