Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

Abstract

Purpose: To review end of life care issues in the intensive care unit (ICU) and how practice variation might affect the ultimate outcome of acute brain injury.

Sources: Bibliographic literature search and personal files.

Findings: In Canada, 10-20% of critically ill adults die in the ICU. Many of these deaths follow acute brain injury in the setting of clinical deterioration, life support limitation and brain death. This brief review addresses some key elements of end of life care for critically ill brain injured patients, including family interactions, making survival predictions, and factors influencing decision-making about cardiopulmonary resuscitation and withdrawal of mechanical ventilation.

Conclusions: Provision of compassionate high quality end of life care should be standard of practice for brain injured and all other critically ill patients who cannot survive. Inconsistencies in end of life care may affect where, when and how patients die, the quality of their death and whether or not they are considered for organ and tissue donation.