RATIONALE: Most deaths in the intensive care unit (ICU) involve withholding or withdrawing multiple life-sustaining therapies, but little is known about how to proceed practically and how this process affects family satisfaction. OBJECTIVES: To examine the duration of life-support withdrawal and its association with overall family satisfaction with care in the ICU. METHODS: We studied family members of 584 patients who died in an ICU at 1 of 14 hospitals after withdrawal of life support and for whom complete medical chart and family questionnaires were available. MEASUREMENTS AND MAIN RESULTS: Data concerning six life-sustaining interventions administered during the last 5 days of life were collected. Families were asked to rate their satisfaction with care using the Family Satisfaction in the ICU questionnaire. For nearly half of the patients (271/584), withdrawal of all life-sustaining interventions took more than 1 day. Patients with a prolonged (>1 d) life-support withdrawal were younger, stayed longer in the ICU, had more life-sustaining interventions, had less often a diagnosis of cancer, and had more decision makers involved. Among patients with longer ICU stays, a longer duration in life-support withdrawal was associated with an increase in family satisfaction with care (P = 0.037). Extubation before death was associated with higher family satisfaction with care (P = 0.009). CONCLUSIONS: Withdrawal of life support is a complex process that depends on patient and family characteristics. Stuttering withdrawal is a frequent phenomenon that seems to be associated with family satisfaction. Extubation before death should be encouraged if possible.
RCT Entities:
RATIONALE: Most deaths in the intensive care unit (ICU) involve withholding or withdrawing multiple life-sustaining therapies, but little is known about how to proceed practically and how this process affects family satisfaction. OBJECTIVES: To examine the duration of life-support withdrawal and its association with overall family satisfaction with care in the ICU. METHODS: We studied family members of 584 patients who died in an ICU at 1 of 14 hospitals after withdrawal of life support and for whom complete medical chart and family questionnaires were available. MEASUREMENTS AND MAIN RESULTS: Data concerning six life-sustaining interventions administered during the last 5 days of life were collected. Families were asked to rate their satisfaction with care using the Family Satisfaction in the ICU questionnaire. For nearly half of the patients (271/584), withdrawal of all life-sustaining interventions took more than 1 day. Patients with a prolonged (>1 d) life-support withdrawal were younger, stayed longer in the ICU, had more life-sustaining interventions, had less often a diagnosis of cancer, and had more decision makers involved. Among patients with longer ICU stays, a longer duration in life-support withdrawal was associated with an increase in family satisfaction with care (P = 0.037). Extubation before death was associated with higher family satisfaction with care (P = 0.009). CONCLUSIONS: Withdrawal of life support is a complex process that depends on patient and family characteristics. Stuttering withdrawal is a frequent phenomenon that seems to be associated with family satisfaction. Extubation before death should be encouraged if possible.
Authors: Graeme M Rocker; Daren K Heyland; Deborah J Cook; Peter M Dodek; Demetrios J Kutsogiannis; Christopher J O'Callaghan Journal: Can J Anaesth Date: 2004 Jun-Jul Impact factor: 5.063
Authors: Daren K Heyland; Graeme M Rocker; Peter M Dodek; Demetrios J Kutsogiannis; Elsie Konopad; Deborah J Cook; Sharon Peters; Joan E Tranmer; Christopher J O'Callaghan Journal: Crit Care Med Date: 2002-07 Impact factor: 7.598
Authors: Lawrence A Ho; Ruth A Engelberg; J Randall Curtis; Judith Nelson; John Luce; Daniel E Ray; Mitchell M Levy Journal: Crit Care Med Date: 2011-05 Impact factor: 7.598
Authors: Claire A Richards; Chuan-Fen Liu; Paul L Hebert; Mary Ersek; Melissa W Wachterman; Lynn F Reinke; Leslie L Taylor; Ann M O'Hare Journal: Clin J Am Soc Nephrol Date: 2019-08-29 Impact factor: 8.237
Authors: David Y Hwang; Daniel Yagoda; Hilary M Perrey; Tara M Tehan; Mary Guanci; Lillian Ananian; Paul F Currier; J Perren Cobb; Jonathan Rosand Journal: J Neurosci Nurs Date: 2014-04 Impact factor: 1.230