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Withdrawing and withholding treatments ICU

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https://www.readbyqxmd.com/read/29886063/changes-in-limitations-of-life-sustaining-treatments-over-time-in-a-french-intensive-care-unit-a-prospective-observational-study
#1
Olivier Lesieur, Alexandre Herbland, Séverin Cabasson, Marie Anne Hoppe, Frédéric Guillaume, Maxime Leloup
BACKGROUND: Variability exists between ICUs in the limitations of therapy. Moreover practices may evolve over time. This single-center observational study aimed to compare withholding or withdrawing practices between 2012 and 2016. METHODS: For each period and patient concerned by limitations, withholding "do-not start", withholding "do-not-increase" and withdrawal measures were recorded. RESULTS: At a four-year interval, the rate of patients undergoing withholding or withdrawal rose from 10 to 23% and 4 to 7%, respectively...
May 31, 2018: Journal of Critical Care
https://www.readbyqxmd.com/read/29774388/withholding-or-withdrawing-of-life-sustaining-therapy-in-older-adults-%C3%A2-80-years-admitted-to-the-intensive-care-unit
#2
Bertrand Guidet, Hans Flaatten, Ariane Boumendil, Alessandro Morandi, Finn H Andersen, Antonio Artigas, Guido Bertolini, Maurizio Cecconi, Steffen Christensen, Loredana Faraldi, Jesper Fjølner, Christian Jung, Brian Marsh, Rui Moreno, Sandra Oeyen, Christina Agwald Öhman, Bernardo Bollen Pinto, Ivo W Soliman, Wojciech Szczeklik, Andreas Valentin, Ximena Watson, Tilemachos Zafeiridis, Dylan W De Lange
PURPOSE: To document and analyse the decision to withhold or withdraw life-sustaining treatment (LST) in a population of very old patients admitted to the ICU. METHODS: This prospective study included intensive care patients aged ≥ 80 years in 309 ICUs from 21 European countries with 30-day mortality follow-up. RESULTS: LST limitation was identified in 1356/5021 (27.2%) of patients: 15% had a withholding decision and 12.2% a withdrawal decision (including those with a previous withholding decision)...
May 17, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29660241/copd-is-independently-associated-with-6-month-survival-in-patients-who-have-life-support-withheld-in-intensive-care
#3
Adel Maamar, Stéphanie Chevalier, Pierre Fillâtre, Vlad Botoc, Yves Le Tulzo, Arnaud Gacouin, Jean-Marc Tadié
BACKGROUND: In-hospital outcomes following decisions of withholding or withdrawing in Intensive Care Unit (ICU) patients have been previously assessed, little is known about outcomes after ICU and hospital discharge. Our objective was to report the 6-month outcomes of discharged patients who had treatment limitations in a general ICU and to identify prognostic factors of survival. METHODS: We retrospectively collected the data of patients discharged from the ICU for whom life support was withheld from 2009 to 2011...
April 16, 2018: Clinical Respiratory Journal
https://www.readbyqxmd.com/read/29546924/-limitation-of-vital-support-in-a-chilean-pediatric-intensive-care-unit-2004-2014
#4
Bettina von Dessauer, Carmen Benavente, Emilia Monje, Jazmina Bongain, Nadia Ordenes
OBJECTIVE: Describe the frequency and characteristics of PICU patients who undergo a process of withholding or withdrawing life-sustaining treatment (LTSV), between 2004 y 2014. PATIENTS AND METHOD: A retrospective, observational descriptive study, using two documents for quality assessment in the PICU of Hospital Roberto del Río: 1) daily individual patient tracking log and 2) daily record of quality indicators, including LTSV, both updated daily at the morning visit...
December 2017: Revista Chilena de Pediatría
https://www.readbyqxmd.com/read/29343041/forgoing-life-sustaining-treatments-in-the-icu-to-withhold-or-to-withdraw-is-that-the-question
#5
Giuseppe R Gristina, Francesca Baroncelli, Marco Vergano
In the last decades, mortality from severe acute illnesses has considerably declined thanks to the advances in intensive care medicine. Meanwhile, critical care physicians realized that lifesustaining treatments (LST) may not be appropriate for every patient, and end-of-life care in the Intensive Care Unit (ICU) started to receive growing attention. Most deaths occurring in the ICU now follow a decision to forgo life-sustaining treatments (DFLST), which can be implemented either by withdrawing (WDLST) or withholding (WHLST) life-sustaining treatments...
January 17, 2018: Minerva Anestesiologica
https://www.readbyqxmd.com/read/29341962/withdrawal-of-life-sustaining-therapy
#6
Barbara G Jericho
PURPOSE OF REVIEW: The aim of this review is to examine literature relating to the withdrawal of life-sustaining therapy (WLST). RECENT FINDINGS: Discussions regarding end-of-life issues in adults and children are not occurring comprehensively. Discussions relating to the WLST in the pediatric population varies by institution and may vary by race, age, health insurance, diagnosis, and severity of illness. Completing advance directives prior to placement of life-sustaining treatments is not consistent practice...
January 15, 2018: Current Opinion in Anaesthesiology
https://www.readbyqxmd.com/read/29302603/what-are-the-ethical-dimensions-in-the-profession-of-intensive-care-specialist
#7
REVIEW
Jean-Pierre Quenot, Fiona Ecarnot, Nicolas Meunier-Beillard, Auguste Dargent, Jean-Pierre Eraldi, François Bougerol, Audrey Large, Pascal Andreu, Jean-Philippe Rigaud
Two essential components of the profession of a medical doctor are the constant review of the patient's therapeutic project, and collaboration between healthcare professionals. The profession of intensive care unit (ICU) physician goes further in terms of responsibility, vis-à-vis the intensive treatments dispensed to the patients, and the physician's responsibilities towards the patient's family and the caregiving team, also bearing in mind that ICU care is costly in terms of human and financial resources...
December 2017: Annals of Translational Medicine
https://www.readbyqxmd.com/read/29247307/attitudes-towards-end-of-life-issues-in-intensive-care-unit-among-italian-anesthesiologists-a-nation-wide-survey
#8
Andrea Cortegiani, Vincenzo Russotto, Santi Maurizio Raineri, Cesare Gregoretti, Antonino Giarratano, Sebastiano Mercadante
BACKGROUND: The aim of this paper is to collect data on the practice of palliative care, withholding and withdrawal of life-sustaining therapies, and management of end of life (EOL) in Italian intensive care units (ICUs). METHODS: Web-based survey among Italian anesthesiologists endorsed by the Italian Society of Anesthesiology Analgesia Reanimation and Intensive Care (SIAARTI). The survey consists of 27 close-ended and 2 open-ended questions. RESULTS: Eight hundred and five persons responded to the full list of questions...
December 15, 2017: Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer
https://www.readbyqxmd.com/read/29142376/intensive-care-nurses-attitude-on-palliative-and-end-of-life-care
#9
Swagata Tripathy, Pragyan K Routray, Jagdish C Mishra
Background: Intensive Care Unit (ICU) nurses have a vital role in the implementation of end of life (EOL) care. There is limited data on the attitude of ICU nurses toward EOL and palliation. Aim: This study aimed to investigate knowledge, attitude, and beliefs of intensive care nurses in eastern India toward EOL. Materials and Methods: A self-administered questionnaire was distributed to delegates in two regional critical care nurses' training programs...
October 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28701412/the-effect-of-blinding-on-estimates-of-mortality-in-randomised-clinical-trials-of-intensive-care-interventions-protocol-for-a-systematic-review-and-meta-analysis
#10
Carl Thomas Anthon, Anders Granholm, Anders Perner, Jon Henrik Laake, Morten Hylander Møller
INTRODUCTION: Evidence exists that unblinded randomised clinical trials (RCTs) overestimate intervention effects compared with blinded RCTs. It has been suggested that this is less pronounced for objective (ie, not subject to interpretation) outcome measures, including mortality. This may not apply in the intensive care unit (ICU), as most deaths are preceded by decisions to withhold or withdraw treatments. Lack of blinding of physicians in RCTs of ICU interventions may potentially influence the decision towards a higher threshold for discontinuing treatment in patients who receive the investigational treatment and/or a lower threshold for discontinuing treatment in patients who receive the comparator (control)...
July 11, 2017: BMJ Open
https://www.readbyqxmd.com/read/28483610/decision-making-on-withholding-or-withdrawing-life-support-in-the-icu-a-worldwide-perspective
#11
MULTICENTER STUDY
Suzana M Lobo, Flávio H B De Simoni, Stephan M Jakob, Angel Estella, Sonali Vadi, Andreas Bluethgen, Ignacio Martin-Loeches, Yasser Sakr, Jean-Louis Vincent
BACKGROUND: Many critically ill patients who die will do so after a decision has been made to withhold/withdraw life-sustaining therapy. The objective of this study was to document the characteristics of ICU patients with a decision to withhold/withdraw life-sustaining treatment, including the types of supportive treatments used, patterns of organ dysfunction, and international differences, including gross national income (GNI). METHODS: In this observational cohort study conducted in 730 ICUs in 84 countries, all adult patients admitted between May 8, 2012, and May 18, 2012 (except admissions for routine postoperative surveillance), were included...
August 2017: Chest
https://www.readbyqxmd.com/read/28152666/provision-of-critical-care-services-to-hiv-infected-children-in-an-era-of-advanced-intensive-care-and-availability-of-combined-antiretroviral-therapy
#12
REVIEW
Prakash M Jeena, Miriam Adhikari
Intensive care facilities are always in demand in the public sector and there is constant competition for beds. Appropriate allocation of children to these resources is based on the ethical principles of distributive justice and beneficence that is determined on the presumed short-term outcome of the acute illness, long-term outcome of the underlying chronic disease and the overall demand for these facilities. At the onset of the HIV epidemic in South Africa, HIV-infected children were refused admission to the paediatric intensive care unit (PICU) on the basis of poor ICU outcomes and the lack of provision of combined antiretroviral therapy (cART) for survivors...
August 2017: Paediatrics and International Child Health
https://www.readbyqxmd.com/read/27288625/end-of-life-care-in-the-intensive-care-unit-report-from-the-task-force-of-world-federation-of-societies-of-intensive-and-critical-care-medicine
#13
John Myburgh, Fayez Abillama, Davide Chiumello, Geoff Dobb, Stephen Jacobe, Ruth Kleinpell, Younsuk Koh, Claudio Martin, Andej Michalsen, Paolo Pelosi, Lluis Blanch Torra, Jean-Louis Vincent, Susan Yeager, Janice Zimmerman
End-of-life care in the intensive care unit (ICU) was identified as an objective in a series of Task Forces developed by the World Federation of Societies of Intensive and Critical Care Medicine Council in 2014. The objective was to develop a generic statement about current knowledge and to identify challenges relevant to the global community that may inform regional and local initiatives. An updated summary of published statements on end-of-life care in the ICU from national Societies is presented, highlighting commonalities and differences within and between international regions...
August 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27071388/withholding-and-withdrawal-of-life-sustaining-treatments-in-low-middle-income-versus-high-income-asian-countries-and-regions
#14
COMPARATIVE STUDY
Jason Phua, Gavin M Joynt, Masaji Nishimura, Yiyun Deng, Sheila Nainan Myatra, Yiong Huak Chan, Nguyen Gia Binh, Cheng Cheng Tan, Mohammad Omar Faruq, Yaseen M Arabi, Bambang Wahjuprajitno, Shih-Feng Liu, Seyed Mohammad Reza Hashemian, Waqar Kashif, Dusit Staworn, Jose Emmanuel Palo, Younsuck Koh
PURPOSE: To compare the attitudes of physicians towards withholding and withdrawing life-sustaining treatments in intensive care units (ICUs) in low-middle-income Asian countries and regions with those in high-income ones, and to explore differences in the role of families and surrogates, legal risks, and financial considerations between these countries and regions. METHODS: Questionnaire study conducted in May-December 2012 on 847 physicians from 255 ICUs in 10 low-middle-income countries and regions according to the World Bank's classification, and 618 physicians from 211 ICUs in six high-income countries and regions...
July 2016: Intensive Care Medicine
https://www.readbyqxmd.com/read/27059989/communication-tools-for-end-of-life-decision-making-in-the-intensive-care-unit-a-systematic-review-and-meta-analysis
#15
REVIEW
Simon J W Oczkowski, Han-Oh Chung, Louise Hanvey, Lawrence Mbuagbaw, John J You
BACKGROUND: For many patients admitted to the intensive care unit (ICU), preferences for end-of-life care are unknown, and clinicians and substitute decision-makers are required to make decisions about the goals of care on their behalf. We conducted a systematic review to determine the effect of structured communication tools for end-of-life decision-making, compared to usual care, upon the number of documented goals of care discussions, documented code status, and decisions to withdraw life-sustaining treatments, in adult patients admitted to the ICU...
April 9, 2016: Critical Care: the Official Journal of the Critical Care Forum
https://www.readbyqxmd.com/read/26927938/modes-of-death-in-a-pediatric-cardiac-icu
#16
Angelo Polito, Cristiana Garisto, Chiara Pezzella, Claudia Iacoella, Paola E Cogo
OBJECTIVE: To determine epidemiology and proximate causes of death in a pediatric cardiac ICU in Southern Europe. DESIGN: Retrospective chart review. SETTING: Single-center institution. PATIENTS: We concurrently identified 57 consecutive patients who died prior to discharge from the cardiac ICU. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Over the study period, there were 57 deaths for a combined mortality rate of 2...
May 2016: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/26895198/the-impact-of-advance-directives-on-end-of-life-care-for-adolescents-and-young-adults-undergoing-hematopoietic-stem-cell-transplant
#17
COMPARATIVE STUDY
Jennifer Needle, Angela R Smith
BACKGROUND: Little is known about the role of advance directives (AD) in end-of-life (EOL) care for adolescents and young adults (AYA) undergoing hematopoietic stem cell transplant (HSCT). OBJECTIVE: The study objective was to describe the frequency, type, and influence of AD on the use of life-sustaining treatment (LST) in AYA patients undergoing HSCT. METHODS: We performed a retrospective chart review of 96 patients aged 14-26 undergoing HSCT between April 2011 and January 2015 at the University of Minnesota...
March 2016: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/26784137/palliative-care-for-patients-dying-in-the-intensive-care-unit-with-chronic-lung-disease-compared-with-metastatic-cancer
#18
RANDOMIZED CONTROLLED TRIAL
Crystal E Brown, Ruth A Engelberg, Elizabeth L Nielsen, J Randall Curtis
RATIONALE: Palliative care has been focused largely on patients with cancer, and yet patients with chronic lung diseases also have high morbidity and mortality. The majority of deaths in intensive care units (ICUs) follow decisions to withhold or withdraw life-sustaining treatments, suggesting that palliative care is critically important in this setting. OBJECTIVES: We explored differences in receipt of elements of palliative care among patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD) who die in ICUs compared with patients with cancer...
May 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/26778794/-withholding-and-withdrawing-treatment-in-patients-admitted-in-an-internal-medicine-ward
#19
R García Caballero, B Herreros, D Real de Asúa, R Alonso, M M Barrera, V Castilla
INTRODUCTION: Many of the patients admitted to a general medical ward have a compromised quality of life, or short life expectancy, so they are potential candidates for withhold/withdraw (WH/WD) treatment. The first objectif was to describe which measures were WH/WD among patients who died during their admission in a general medical ward from a tertiary hospital in Madrid. Secondly, to define the clinical characteristics of this population. MATERIAL AND METHODS: A cross-sectional descriptive study during 6 months from 2011 and 2012 of all the patients dead while their admission in the Internal Medicine Department...
March 2016: Revista de Calidad Asistencial: Organo de la Sociedad Española de Calidad Asistencial
https://www.readbyqxmd.com/read/26725047/us-physicians-opinions-about-distinctions-between-withdrawing-and-withholding-life-sustaining-treatment
#20
Grace S Chung, John D Yoon, Kenneth A Rasinski, Farr A Curlin
Decisions to withhold or withdraw life-sustaining treatment (LST) precede the majority of ICU deaths. Although professional guidelines generally treat the two as ethically equivalent, evidence suggests withdrawing LST is often more psychologically difficult than withholding it. The aim of the experiment was to investigate whether physicians are more supportive of withholding LST than withdrawing it and to assess how physicians' opinions are shaped by their religious characteristics, specialty, and experience caring for dying patients...
October 2016: Journal of Religion and Health
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