James Downar1, Jesse W Delaney2, Laura Hawryluck3, Lisa Kenny4. 1. Divisions of Critical Care Medicine and Palliative Care, University of Toronto, Toronto, Canada. james.downar@utoronto.ca. 2. Rouge Valley Health System, Toronto, Canada. 3. Division of Critical Care Medicine, University of Toronto, Toronto, Canada. 4. Faculty of Medicine, Memorial University of Newfoundland, St. John's, Canada.
Abstract
BACKGROUND: Withdrawal of life-sustaining measures is a common event in the intensive care unit yet it involves a complex balance of medical, legal and ethical considerations. Very few healthcare providers have been specifically trained to withdraw life-sustaining measures, and no comprehensive guidelines exist to help ensure clinicians deliver the highest quality of care to patients and families. Hence, we sought to develop guidelines for the process of withdrawing life-sustaining measures in the clinical setting. METHODS: We convened an interdisciplinary group of ICU care providers from the Canadian Critical Care Society and the Canadian Association of Critical Care Nurses, and used a modified Delphi process to answer key clinical and ethical questions identified in the literature. RESULTS: A total of 39 experienced clinicians completed the initial workshop, and 36 were involved in the subsequent Delphi rounds. The group developed a series of guidelines to address (1) preparing for withdrawal of life-sustaining measures; (2) assessment of distress; (3) pharmaceutical management of distress; and (4) discontinuation of life-sustaining measures and monitoring. The group achieved consensus on all aspects of the guidelines after the third Delphi round. CONCLUSION: We present these guidelines to help physicians provide high-quality end of life (EOL) care in the ICU. Future studies should address their effectiveness from both critical care team and family perspectives.
BACKGROUND: Withdrawal of life-sustaining measures is a common event in the intensive care unit yet it involves a complex balance of medical, legal and ethical considerations. Very few healthcare providers have been specifically trained to withdraw life-sustaining measures, and no comprehensive guidelines exist to help ensure clinicians deliver the highest quality of care to patients and families. Hence, we sought to develop guidelines for the process of withdrawing life-sustaining measures in the clinical setting. METHODS: We convened an interdisciplinary group of ICU care providers from the Canadian Critical Care Society and the Canadian Association of Critical Care Nurses, and used a modified Delphi process to answer key clinical and ethical questions identified in the literature. RESULTS: A total of 39 experienced clinicians completed the initial workshop, and 36 were involved in the subsequent Delphi rounds. The group developed a series of guidelines to address (1) preparing for withdrawal of life-sustaining measures; (2) assessment of distress; (3) pharmaceutical management of distress; and (4) discontinuation of life-sustaining measures and monitoring. The group achieved consensus on all aspects of the guidelines after the third Delphi round. CONCLUSION: We present these guidelines to help physicians provide high-quality end of life (EOL) care in the ICU. Future studies should address their effectiveness from both critical care team and family perspectives.
Entities:
Keywords:
Consensus; Critical care; Delphi technique; Life support care; Palliative care; Standards; Terminal care
Authors: Gordon H Guyatt; Andrew D Oxman; Gunn E Vist; Regina Kunz; Yngve Falck-Ytter; Pablo Alonso-Coello; Holger J Schünemann Journal: BMJ Date: 2008-04-26
Authors: Corey R Fehnel; Miguel Armengol de la Hoz; Leo A Celi; Margaret L Campbell; Khalid Hanafy; Ala Nozari; Douglas B White; Susan L Mitchell Journal: Chest Date: 2020-04-28 Impact factor: 9.410
Authors: John G Laffey; Giacomo Bellani; Tài Pham; Eddy Fan; Fabiana Madotto; Ednan K Bajwa; Laurent Brochard; Kevin Clarkson; Andres Esteban; Luciano Gattinoni; Frank van Haren; Leo M Heunks; Kiyoyasu Kurahashi; Jon Henrik Laake; Anders Larsson; Daniel F McAuley; Lia McNamee; Nicolas Nin; Haibo Qiu; Marco Ranieri; Gordon D Rubenfeld; B Taylor Thompson; Hermann Wrigge; Arthur S Slutsky; Antonio Pesenti Journal: Intensive Care Med Date: 2016-10-18 Impact factor: 17.440