Featured Research

from universities, journals, and other organizations

Withdrawal Of Life Support Often An Imperfect Compromise

Date:
October 7, 2008
Source:
American Thoracic Society
Summary:
Intensive Care Unit doctors seeking to balance the complex needs of their patients and the patients' families may make an imperfect compromise, withdrawing life support systems over a prolonged period of time. This practice is much more common than previously believed, and is also surprisingly associated with higher satisfaction with care -- at least among surviving family members.

Intensive Care Unit (ICU) doctors seeking to balance the complex needs of their patients and the patients' families may make an imperfect compromise, withdrawing life support systems over a prolonged period of time. This practice is much more common than previously believed, and is also surprisingly associated with higher satisfaction with care-at least among surviving family members.

Related Articles


"We found that sequential withdrawal of life support is not as rare a phenomenon as previously believed," wrote J. Randall Curtis, M.D., M.P.H., section chief for pulmonary and critical care medicine at the Harborview Medical Center and the University of Washington, in Seattle. "It occurred in nearly half of the patients we studied."

The findings will be published in the second issue for October of the American Journal of Respiratory and Critical Care Medicine, published by the American Thoracic Society. The study was funded by the National Institute of Nursing Research.

Dr. Curtis and colleagues examined medical charts and family questionnaires for more than 500 patients who had died at the ICU or within 24 hours of discharge out of a pool of 2,003 consecutive patients in 15 Seattle or Tacoma hospitals. During their final days, the patients studied were on a median of four life-support systems, from mechanical ventilation to tube feeding.

Interestingly, among patients whose stays at the ICU were more prolonged, families seemed to be more satisfied when the withdrawal process was longer. "This finding is in the opposite direction to our original hypothesis," wrote Dr. Curtis, noting that "a longer duration of withdrawal of life support seems unlikely to be beneficial for the patient because it represents the prolongation of non-beneficial and sometimes painful therapies in a situation in which life-sustaining therapies are being withdrawn in anticipation of death."

A possible explanation for the higher rate of satisfaction among the families of patients who were removed from life support over time is that poor communication between physicians and families impedes decision making and delays the families' emotional readiness.

"Families need time and support to move from a situation of focusing on hoping for the patient's survival, to a situation in which they have accepted that death is inevitable and they are preparing for the best death possible. If families are not adequately prepared for such a transition, withholding all therapies the same day, followed by a quick death, could be experienced as abandonment," said Dr. Curtis.

Dr. Curtis and colleagues believe that, while sequential withdrawal of life support may be experienced more positively by some families, it is nonetheless a result of "incomplete decision making [that] serves as a way to compensate for the existing gap between physicians' decisions and family expectations."

The study also found if patients were extubated prior to death, family satisfaction tended to be higher, suggesting that extubation may be the best approach for many patients undergoing withdrawal of life support.

"The take home message" says Dr. Curtis "is not to prolong the withdrawal of life-sustaining therapies to the possible detriment of the patient, but to facilitate better communication between ICU clinicians and patients' families. When physicians make a decision to withdraw support, they have often not prepared the family sufficiently and physicians may consequently embark on 'stuttering' withdrawal of life support in order to have more time to prepare the family."

Dr. Curtis concluded: "A better solution for improving family experience while also providing the best possible care to patients is to prepare the family for the possibility of the patient's death earlier in the ICU stay rather than waiting until the physicians have decided that withdrawal of life support is indicated."


Story Source:

The above story is based on materials provided by American Thoracic Society. Note: Materials may be edited for content and length.


Cite This Page:

American Thoracic Society. "Withdrawal Of Life Support Often An Imperfect Compromise." ScienceDaily. ScienceDaily, 7 October 2008. <www.sciencedaily.com/releases/2008/10/081007073926.htm>.
American Thoracic Society. (2008, October 7). Withdrawal Of Life Support Often An Imperfect Compromise. ScienceDaily. Retrieved March 4, 2015 from www.sciencedaily.com/releases/2008/10/081007073926.htm
American Thoracic Society. "Withdrawal Of Life Support Often An Imperfect Compromise." ScienceDaily. www.sciencedaily.com/releases/2008/10/081007073926.htm (accessed March 4, 2015).

Share This


More From ScienceDaily



More Health & Medicine News

Wednesday, March 4, 2015

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Adults Only Get The Flu Twice A Decade, Researchers Say

Adults Only Get The Flu Twice A Decade, Researchers Say

Newsy (Mar. 4, 2015) Researchers found adults only get the flu about once every five years. Scientists analyzed how a person&apos;s immunity builds up over time as well. Video provided by Newsy
Powered by NewsLook.com
Mount Everest Has a Poop Problem

Mount Everest Has a Poop Problem

Buzz60 (Mar. 4, 2015) With no bathrooms to use, climbers of Mount Everest have been leaving human waste on the mountain for years, and it&apos;s becoming a health issue. Mike Janela (@mikejanela) has more. Video provided by Buzz60
Powered by NewsLook.com
The Best Tips to 'Skinny' Your Home

The Best Tips to 'Skinny' Your Home

Buzz60 (Mar. 4, 2015) If you&apos;re looking to reach your health goals this season, there are a few simple tips to help you spring clean your space and improve your nutrition. Krystin Goodwin (@krystingoodwin) has the skinny on keeping a healthy home. Video provided by Buzz60
Powered by NewsLook.com
Analysis: Supreme Court Hears ACA Challenge

Analysis: Supreme Court Hears ACA Challenge

AP (Mar. 4, 2015) Associated Press legal reporter Mark Sherman breaks down the details of the latest Affordable Care Act challenge to make it to the Supreme Court. (March 4) Video provided by AP
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:

Strange & Offbeat Stories


Health & Medicine

Mind & Brain

Living & Well

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins