Withholding and withdrawal of life-sustaining therapies in intensive care: an Australian experience

Abstract

Objectives: Withholding and withdrawal of treatment in intensive care is currently widely accepted, but little has been published about Australian practice.

Design and setting: Retrospective audit of all deaths in two major tertiary intensive care units in the Hunter New England Area Health Service during 2008. Patients who died were classified as "no limitations" (died while receiving full treatment), "treatments withheld" (specific treatment limitations) or "withdrawal of life-sustaining treatment" (WLST).

Results: Of 1950 patients admitted to an ICU, 283 died (14.5%). Of these 283, 54 (19%) died despite all therapeutic efforts; 97 (34%) had treatments withheld, and 132 (47%) had WLST. There were no statistically significant differences in length of stay between the three groups. Patients who died despite all therapeutic efforts were younger than those who died after treatments were withheld or WLST (mean age [SD], 58.7 [21.1] v 73.1 [12.5] v 69.3 [13.5]; P = 0.001). APACHE II score was higher in the group who died than in the total ICU group (mean [SD], 25.5 [8.3] v 17.7 [8.7], P = 0.001).

Conclusions: In this population of critically ill patients, most deaths occurred after discussion of end-of-life decisions and withholding or withdrawal of treatment.