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• W2080475992 abstract "Study objective To compare and contrast use oftechnology, pharmacology, and physician variability in end-of-life careof ICU patients dying with or without active life support. Design Retrospective cohort study. Setting Two medical-surgical tertiary-care ICUs in aCanadian regional referral teaching hospital. Participants One hundred seventy-four patients who diedbetween July 1, 1996, and June 30, 1997. Intervention Data abstraction from medical records. Results Patients in whom life support was withheld or withdrawn (138 of 174,79%) were older (65 ± 16 years vs 55 ± 18 years; p < 0.05[mean ± SD]). Once the decision to withdraw life support was made,death occurred in 4.3 h (2.1 to 6.5 h; mean [95% confidenceinterval]). Patients who had active life support treatment until deathreceived more support measures including inotropic agents (36 of 36 vs21 of 138; p < 0.05), dialysis (4 of 36 vs 2 of 138; p < 0.05),and mechanical ventilation at the time of death (36 of 36 vs 81 of 138;p < 0.05). Physician differences (> 10-fold) were detected forprescribed doses of morphine and sedative agents whether or not lifesupport was withheld or withdrawn. The median cumulative dose ofmorphine prescribed during the final 12 h was larger(fivefold) in patients undergoing withdrawal of life support. Nodocumented discussion of life support withdrawal was noted in one case.In the remaining patients, the 10 staff physicians were documented tobe involved in 77% (range, 54 to 94%) of the end-of-lifediscussions. Conclusions Differences were evident intechnologic and pharmacologic support and in physician prescribinghabits in patients for whom life support was or was not withheld orwithdrawn. Substantial variability was noted in physician documentationof physician-family interactions surrounding the withdrawal of lifesupport. To compare and contrast use oftechnology, pharmacology, and physician variability in end-of-life careof ICU patients dying with or without active life support. Retrospective cohort study. Two medical-surgical tertiary-care ICUs in aCanadian regional referral teaching hospital. One hundred seventy-four patients who diedbetween July 1, 1996, and June 30, 1997. Data abstraction from medical records. Patients in whom life support was withheld or withdrawn (138 of 174,79%) were older (65 ± 16 years vs 55 ± 18 years; p < 0.05[mean ± SD]). Once the decision to withdraw life support was made,death occurred in 4.3 h (2.1 to 6.5 h; mean [95% confidenceinterval]). Patients who had active life support treatment until deathreceived more support measures including inotropic agents (36 of 36 vs21 of 138; p < 0.05), dialysis (4 of 36 vs 2 of 138; p < 0.05),and mechanical ventilation at the time of death (36 of 36 vs 81 of 138;p < 0.05). Physician differences (> 10-fold) were detected forprescribed doses of morphine and sedative agents whether or not lifesupport was withheld or withdrawn. The median cumulative dose ofmorphine prescribed during the final 12 h was larger(fivefold) in patients undergoing withdrawal of life support. Nodocumented discussion of life support withdrawal was noted in one case.In the remaining patients, the 10 staff physicians were documented tobe involved in 77% (range, 54 to 94%) of the end-of-lifediscussions. Differences were evident intechnologic and pharmacologic support and in physician prescribinghabits in patients for whom life support was or was not withheld orwithdrawn. Substantial variability was noted in physician documentationof physician-family interactions surrounding the withdrawal of lifesupport." @default.
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• W2080475992 date "2000-11-01" @default.
• W2080475992 modified "2023-10-06" @default.
• W2080475992 title "End-of-Life Care in the ICU" @default.
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• W2080475992 doi "https://doi.org/10.1378/chest.118.5.1424" @default.
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