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Medline ® Abstract for Reference 46

of 'Palliative care: Issues in the intensive care unit in adults'

Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.
Gerstel E, Engelberg RA, Koepsell T, Curtis JR
Am J Respir Crit Care Med. 2008;178(8):798. Epub 2008 Aug 14.
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. Patientswith 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.
Departments of Internal Medicine and Critical Care, Geneva University Hospitals of Geneva and University of Geneva, Geneva, Switzerland.