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Withdrawing and withholding treatments ICU

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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
#1
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
#2
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
#3
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...
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/26514821/-decision-conflicts-with-relatives-in-the-intensive-care-unit
#9
M Ratliff, J-O Neumann
BACKGROUND: If medicine is coming close to its limits conflicts sometimes occur. Most conflicts in the intensive care unit (ICU) involve the medical team and patients' relatives. In particular decisions about withholding and withdrawing life-sustaining therapy lead to conflicts. Decisions about limiting life-sustaining treatment are burdened by conflicts and put an enormous strain particularly on relatives. AIM: Illustration of currently available studies and existing recommendations on how to manage potentially conflict-laden decision-finding discussions on the ICU are presented...
October 2016: Medizinische Klinik, Intensivmedizin und Notfallmedizin
https://www.readbyqxmd.com/read/26388551/end-of-life-decisions-in-the-intensive-care-unit-icu-exploring-the-experiences-of-icu-nurses-and-doctors-a-critical-literature-review
#10
REVIEW
Liz Flannery, Lucie Michelle Ramjan, Kath Peters
BACKGROUND: End-of-life decision making in the Intensive Care Unit (ICU), can be emotionally challenging and multifaceted. Doctors and nurses are sometimes placed in a precarious position where they are required to make decisions for patients who may be unable to participate in the decision-making process. There is an increasing frequency of the need for such decisions to be made in ICU, with studies reporting that most ICU deaths are heralded by a decision to withdraw or withhold life-sustaining treatment...
May 2016: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/26154929/integrating-palliative-care-into-the-care-of-neurocritically-ill-patients-a-report-from-the-improving-palliative-care-in-the-icu-project-advisory-board-and-the-center-to-advance-palliative-care
#11
Jennifer A Frontera, J Randall Curtis, Judith E Nelson, Margaret Campbell, Michelle Gabriel, Anne C Mosenthal, Colleen Mulkerin, Kathleen A Puntillo, Daniel E Ray, Rick Bassett, Renee D Boss, Dana R Lustbader, Karen J Brasel, Stefanie P Weiss, David E Weissman
OBJECTIVES: To describe unique features of neurocritical illness that are relevant to provision of high-quality palliative care; to discuss key prognostic aids and their limitations for neurocritical illnesses; to review challenges and strategies for establishing realistic goals of care for patients in the neuro-ICU; and to describe elements of best practice concerning symptom management, limitation of life support, and organ donation for the neurocritically ill. DATA SOURCES: A search of PubMed and MEDLINE was conducted from inception through January 2015 for all English-language articles using the term "palliative care," "supportive care," "end-of-life care," "withdrawal of life-sustaining therapy," "limitation of life support," "prognosis," or "goals of care" together with "neurocritical care," "neurointensive care," "neurological," "stroke," "subarachnoid hemorrhage," "intracerebral hemorrhage," or "brain injury...
September 2015: Critical Care Medicine
https://www.readbyqxmd.com/read/26149302/respective-impact-of-no-escalation-of-treatment-withholding-and-withdrawal-of-life-sustaining-treatment-on-icu-patients-prognosis-a-multicenter-study-of-the-outcomerea-research-group
#12
Alexandre Lautrette, Maïté Garrouste-Orgeas, Pierre-Marie Bertrand, Dany Goldgran-Toledano, Samir Jamali, Virginie Laurent, Laurent Argaud, Carole Schwebel, Bruno Mourvillier, Michaël Darmon, Stéphane Ruckly, Anne-Sylvie Dumenil, Virginie Lemiale, Bertrand Souweine, Jean-François Timsit
PURPOSE: To assess the prevalence of decisions to forgo life-sustaining treatment (DFLST), the patients characteristics, and to estimate the impact of DFLST stages on mortality. METHODS: Observational study of a prospective database between 2005 and 2012 from 13 ICUs. DFLST were defined as follows: no escalation of treatment (stage 1), not to start or escalate treatment even if such treatment is considered in the future; withholding (stage 2), not to start or escalate necessary treatment; withdrawal (stage 3), to stop necessary treatment...
October 2015: Intensive Care Medicine
https://www.readbyqxmd.com/read/26092498/withholding-or-withdrawal-of-treatment-under-french-rules-a-study-performed-in-43-intensive-care-units
#13
Olivier Lesieur, Maxime Leloup, Frédéric Gonzalez, Marie-France Mamzer
BACKGROUND: In France, decisions to limit treatment fall under the Leonetti law adopted in 2005. Leading figures from the French world of politics, science, and justice recently claimed for amendments to the law, considering it incomplete. This study, conducted before any legislative change, aimed to investigate the procedural aspects of withholding/withdrawing treatment in French ICUs and their adequacy with the existing law. METHODS: The characteristics of patients qualified for a withholding/withdrawal procedure were prospectively collected in 43 French ICUs...
December 2015: Annals of Intensive Care
https://www.readbyqxmd.com/read/25943254/turkish-critical-care-nurses-views-on-end-of-life-decision-making-and-practices
#14
Aysel Badır, İbrahim Topçu, Emine Türkmen, Nilgün Göktepe, Mukaddes Miral, Nermin Ersoy, Esra Akın
BACKGROUND: Life-sustaining treatments are increasingly used in intensive care units (ICUs) for EOL care, but the decision to use these may cause ethical issues. AIMS AND OBJECTIVES: The aim of this study was to investigate the views and practices of critical care nurses in Turkey on the end-of-life (EOL) care. DESIGN: This was a cross-sectional study. METHODS: The research was conducted in 32 second- and third-level ICUs of 19 Ministry of Health research hospitals in Turkey...
May 6, 2015: Nursing in Critical Care
https://www.readbyqxmd.com/read/25904183/global-variability-in-withholding-and-withdrawal-of-life-sustaining-treatment-in-the-intensive-care-unit-a-systematic-review
#15
REVIEW
N M Mark, S G Rayner, N J Lee, J R Curtis
PURPOSE: Prior studies identified high variability in prevalence of withdrawal of life-sustaining treatment in the ICU. Variability in end-of-life decision-making has been reported at many levels: between countries, ICUs, and individual intensivists. We performed a systematic review examining regional, national, inter-hospital, and inter-physician variability in withdrawal of life-sustaining treatment in the ICU. METHODS: Using a predefined search strategy, we queried three electronic databases for peer-reviewed articles addressing withdrawal of life-sustaining treatment in adult patients in the ICU...
September 2015: Intensive Care Medicine
https://www.readbyqxmd.com/read/25840865/attitudes-towards-euthanasia-among-greek-intensive-care-unit-physicians-and-nurses
#16
Georgios Kranidiotis, Julia Ropa, John Mprianas, Theodoros Kyprianou, Serafim Nanas
OBJECTIVES: To investigate the attitudes of Greek intensive care unit (ICU) medical and nursing staff towards euthanasia. BACKGROUND: ICU physicians and nurses deal with end-of-life dilemmas on a daily basis. Therefore, the exploration of their stances on euthanasia is worthwhile. METHODS: This was a descriptive quantitative study conducted in three ICUs in Athens. The convenience sample included 39 physicians and 107 nurses. RESULTS: Of respondents, 52% defined euthanasia inaccurately, as withholding or withdrawal of treatment, while 15% ranked limitation of life-support among the several forms of euthanasia, together with active shortening of the dying process and physician - assisted suicide...
May 2015: Heart & Lung: the Journal of Critical Care
https://www.readbyqxmd.com/read/25648380/negotiated-reorienting-a-grounded-theory-of-nurses-end-of-life-decision-making-in-the-intensive-care-unit
#17
Ann Gallagher, Regina Szylit Bousso, Joan McCarthy, Helen Kohlen, Tom Andrews, Maria Cristina Paganini, Nasser Ibrahim Abu-El-Noor, Anna Cox, Margit Haas, Anne Arber, Mysoon Khalil Abu-El-Noor, Michelle Freire Baliza, Katia Grillo Padilha
BACKGROUND: Intensive care units (ICUs) focus on treatment for those who are critically ill and interventions to prolong life. Ethical issues arise when decisions have to be made regarding the withdrawal and withholding of life-sustaining treatment and the shift to comfort and palliative care. These issues are particularly challenging for nurses when there are varying degrees of uncertainty regarding prognosis. Little is known about nurses' end-of-life (EoL) decision-making practice across cultures...
April 2015: International Journal of Nursing Studies
https://www.readbyqxmd.com/read/25625339/discontinuance-of-life-sustaining-treatment-utilizing-ketamine-for-symptom-management
#18
Danielle M Noreika, Patrick Coyne
We present the case of an otherwise healthy 21-year-old female who developed severe respiratory failure following a minor procedure requiring ECMO and bi-level ventilation. During her protracted ICU course, she had significant difficulties with agitation and was titrated to the following regimen: hydromorphone 30 mg/hour, fentanyl 200 mcg/hour, dexmedetomidine 1.5 mcg/kg/hour, propofol at 70 mcg/kg/min, and midazolam at 20 mg/hour. We were consulted to assist in withdrawal of life prolonging measures at the family's request and given high doses of commonly used opioid and sedative medications successfully utilized methadone and ketamine for symptom control...
March 2015: Journal of Pain & Palliative Care Pharmacotherapy
https://www.readbyqxmd.com/read/25622109/the-possible-impact-of-the-german-drgs-reimbursement-system-on-end-of-life-decision-making-in-a-surgical-intensive-care-unit
#19
Peter Stachura, Peter Oberender, Anika C Bundscherer, Christoph H R Wiese
BACKGROUND: More than 70 % of critically ill patients die in intensive care units (ICUs) after treatment is reduced. End-of-life decision making in the ICU is a grey area that varies in practice, and there are potential economic consequences of over- and under-treatment. The aim of this study was to describe the end-of-life decisions of critically ill patients in a surgical ICU in Germany and to identify how financial incentives may influence decision making. METHODS: Data on the admission diagnosis, end-of-life decision making and cause of death were obtained for 69 critically ill patients who died in the ICU (Hospital of Bayreuth, Germany) in 2009...
February 2015: Wiener Klinische Wochenschrift
https://www.readbyqxmd.com/read/25335864/experiences-of-slovene-icu-physicians-with-end-of-life-decision-making-a-nation-wide-survey
#20
Urh Groselj, Miha Orazem, Maja Kanic, Gaj Vidmar, Stefan Grosek
BACKGROUND: Advances in intensive care medicine have enormously improved ability to successfully treat seriously ill patients. However, intensive treatment and prolongation of life is not always in the patient's best interest, and many ethical dilemmas arise in end-of-life (EOL) situations. We aimed to assess intensive care unit (ICU) physicians' experiences with EOL decision making and to compare the responses according to ICU type. MATERIAL AND METHODS: A cross-sectional survey was performed in all 35 Slovene ICUs, using a questionnaire designed to assess ICU physician experiences with EOL decision making, focusing on limitations of life-sustaining treatments (LST)...
2014: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
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