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Randomized Controlled Trial
. 2008 Oct 15;178(8):798-804.
doi: 10.1164/rccm.200711-1617OC. Epub 2008 Aug 14.

Duration of withdrawal of life support in the intensive care unit and association with family satisfaction

Eric Gerstel  1 , Ruth A Engelberg, Thomas Koepsell, J Randall Curtis
Affiliations
Randomized Controlled Trial

Duration of withdrawal of life support in the intensive care unit and association with family satisfaction

Eric Gerstel et al. Am J Respir Crit Care Med. .

Abstract

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.

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Figures

<b>Figure 1.</b>
Figure 1.
Time sequence of life-sustaining therapies/interventions withdrawal. Mean and 95% confidence intervals of the mean of duration between therapy/intervention interruption and death or transfer (confidence intervals obtained by bootstrap analysis). RRT = renal replacement therapy.
See this image and copyright information in PMC

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