End-of-life decisions during intensive care treatment

Current Opinion in Anaesthesiology

Volumn 16, Issue 2, 2003, Pages 221-225

  Booij, Leo H D J ^a  

^a RADBOUD UNIVERSITY MEDICAL CENTER   (Netherlands)

Author keywords

End of life decisions; Family participation, ethics; Intensive care treatment

Indexed keywords

ANALGESIA; ANXIETY; DECISION MAKING; DEPRESSION; ETHICS; FAMILY; HEALTH CARE COST; HOSPITAL ADMISSION; INTENSIVE CARE; INTENSIVE CARE UNIT; INTERPERSONAL COMMUNICATION; PEDIATRICS; PHYSICIAN ATTITUDE; PRIORITY JOURNAL; RESUSCITATION; REVIEW; SEDATION; TERMINAL CARE;

EID: 0037398436     PISSN: 09527907     EISSN: None     Source Type: Journal    
DOI: 10.1097/00001503-200304000-00018     Document Type: Review

References (17)

1. Rivera-Fernandez R, Sanchez-Cruz JJ, Abizanda-Campos R, Váquez-Mata G. Quality of life before intensive care unit admission and its influence on resource utilization and mortality rate. Crit Care Med 2001; 29:1701-1709. This was an interesting study on the effect of pre-admission quality of life on mortality. It confirms that only patients with a reasonable to good prognosis should be admitted to the ICU.
2. Joynt GM, Gomersall CD, Tan P, et al. Prospective evaluation of patients refused admission to an intensive care unit: triage, futility and outcome. Intensive Care Med 2001; 27:1459-1465. This excellent study examined the reasons for refusal of ICU admission. It showed that mortality is higher in the refused group than in the accepted group of patients and occurs mainly in the group where admission is not indicated because of futility of care, The relatively high survival (40%) rate reflects poor triage and the relatively large number of patients refused because they were not sick enough.
3. Rubenfeld GD, Curtis JR, for the end-of-life care in the ICU working group. End-of-life care in the intensive care unit: A research agenda. Crit Care Med 2001; 29:2001-2006. This paper indicates possible fields of research for end of life care in the ICU.
4. Cook DJ, Guyatt R, Sjokvist P, et al. For the Canadian Critical Care Trials Group. Cardiopulmonary resuscitation directives on admission to intensive care unit: an international observational study. Lancet 2001; 358:1941-1944. This important international study described the incidence of do-not-resuscitate directives in adult ICU-patients. It amazingly demonstrated that a number of patients are admitted to the ICU although they do not want to be resuscitated. Also mentally competent patients had fewer do-not-resuscitate orders than incompetent patients.
5. Esteban A, Gordo F, Solsona JF, et al. Withdrawing and withholding life support in the intensive care unit: a Spanish prospective multi-centre observational study. Intensive Care Med 2001; 27:1744-1749. This was an important prospective study on withholding and withdrawing therapy in the ICU, showing that not all end-of-life decisions are made by both physicians and relatives. It confirmed that withholding therapy is more frequent than withdrawal of therapy. The results are in agreement with earlier European study results.
6. Crawley LM, Marshall PA, Lo B, Koenig BA. For the End-of-Life care consensus panel. Strategies for culturally effective End-of-Life care. Ann Intern Med 2002; 136:673-679. In this study it was once more demonstrated that sociocultural and religious factors play an important role in end-of-life decisions.
7. Holzapfel L, Demingeon G, Piralla B. A four step protocol of limitation of treatment in terminal care. An observational study in 475 ICU patients. Intensive Care Med 2002; 28:1309-1315. The study proved that involving all care-providers and the relatives in decision making in end-of-life care facilitates the acceptance of such decisions. The authors provide a clear and useful procedure to be followed in this process.
8. Truog RD, Burns JP. Excellence in end-of-life care: a new goal for intensivists. Intensive Care Med 2002; 28:1197-1199. The authors provide some useful amendments to the guidelines of Holzapfel et al.
9. Pochard F, Azoulay E, Chevret S, et al. Symptoms of anxiety and depression in family members of intensive care unit patients: ethical hypothesis regarding decision-making capacity. Crit Care Med 2001; 29:1893-1897. The authors of this report discuss the occurrence of anxiety and depression in relatives as a factor influencing decision making when they are asked to be a designated person in end-of-life decisions.
10. Hikka H, Kosunen E, Lammi UK, et al. Decision making in terminal care: a survey of Finnish doctors' treatment decisions in end-of-life scenarios involving a terminal cancer and a terminal dementia patient. Pall Med 2002; 16:195-204. This study confirmed that in Scandinavia end-of-life decisions are similar to those in other countries. It demonstrates that in physicians treating paediatric patients, a more restrictive attitude is present.
11. Hawryluck LA, Harvey WRC, Lemieux-Charles L, Singer PA. Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Medical Ethics 2002; 3:3. This paper describes consensus guidelines for end-of-life decisions developed with a Delphi method.
12. Ankrom M, Zelesnick L, Barofsky I, et al. Elective discontinuation of life-sustaining mechanical ventilation on a chronic ventilator unit. J Am Geriatr Soc 2001; 49:1549-1554. The authors show that the decisions in a chronic ventilation unit are made along similar lines as in the ICU.
13. Luce JM. Three patients who asked that life support be withhold or withdrawn in the surgical intensive care unit. Crit Care Med 2002; 30:775-780. On the basis of three case reports it is demonstrated that conditions rapidly change and may influence decision taking.
14. Stevens L, Cook D, Guyatt G, et al. Education, ethics, and end-of-life decisions in the intensive care unit. Crit Care Med 2002; 30:290-296. Education and possessing experience are important determinants in adequacy of end-of-life decisions.
15. Pettilä V, Aloakko T, Varpula T, et al. On behalf of the Finnish SSAI candidates. On what are our end-of-life decisions based? Acta Anaesthesiol Scand 2002; 46:947-954. This case study describes the most frequent ways of withholding and withdrawing therapy and proves that three physicians should be included to make justified decisions.
16. Meyer EC, Burns JP, Griffith JL, Truog RD. Parental perspectives on end-of-life care in the pediatric intensive care unit. Crit Care Med 2002; 30:226-231. This study demonstrates the parental involvement in end-of-life decisions in paediatric patients.
17. Luce JM, Rubenfeld GD. Can health care cost be reduced by limiting intensive care at the end of life? Am J Respir Crit Care Med 2002; 165:750-754. This study confirms that the last days of life do not really contribute to the cost of ICU treatment. It means that not treating dying patients in the ICU does not result in a significant limitation of healthcare cost.