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Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.

ABSTRACT: 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.To examine the duration of life-support withdrawal and its association with overall family satisfaction with care in the ICU.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.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. Patients with 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).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.

SUBMITTER: Gerstel E

PROVIDER: S-EPMC2566791 | biostudies-literature | 2008 Oct

REPOSITORIES: biostudies-literature

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Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.

Gerstel Eric E Engelberg Ruth A RA Koepsell Thomas T Curtis J Randall JR

American journal of respiratory and critical care medicine 20080814 8

<h4>Rationale</h4>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.<h4>Objectives</h4>To examine the duration of life-support withdrawal and its association with overall family satisfaction with care in the ICU.<h4>Methods</h4>We studied family members of 584 patients who died in an ICU at 1 of 14 hospitals after withdrawal of li ...[more]

PMID: 18703787

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Project description:ImportanceIncreased patient acuity, decreased intensive care unit (ICU) bed availability, and a shortage of intensivist physicians have led to strained ICU capacity. The resulting increase in emergency department (ED) boarding time for patients requiring ICU-level care has been associated with worse outcomes.ObjectiveTo determine the association of a novel ED-based ICU, the Emergency Critical Care Center (EC3), with 30-day mortality and inpatient ICU admission.Design, setting, and participantsThis retrospective cohort study used electronic health records of all ED visits between September 1, 2012, and July 31, 2017, with a documented clinician encounter at a large academic medical center in the United States with approximately 75 000 adult ED visits per year. The pre-EC3 cohort included ED patients from September 2, 2012, to February 15, 2015, when the EC3 opened, and the post-EC3 cohort included ED patients from February 16, 2015, to July 31, 2017. Data analyses were conducted from March 2, 2018, to May 28, 2019.ExposuresImplementation of EC3, an ED-based ICU designed to provide rapid initiation of ICU-level care in the ED setting and seamless transition to inpatient ICUs.Main outcomes and measuresThe main outcomes were 30-day mortality among ED patients and rate of ED to ICU admission.ResultsA total of 349 310 visits from a consecutive sample of ED patients (mean [SD] age, 48.5 [19.7] years; 189 709 [54.3%] women) were examined; the pre-EC3 cohort included 168 877 visits and the post-EC3 cohort included 180 433 visits. Implementation of EC3 was associated with a statistically significant reduction in risk-adjusted 30-day mortality among all ED patients (pre-EC3, 2.13%; post-EC3, 1.83%; adjusted odds ratio, 0.85; 95% CI, 0.80-0.90; number needed to treat, 333 patient encounters; 95% CI, 256-476). The risk-adjusted rate of ED admission to ICU decreased with implementation of EC3 (pre-EC3, 3.2%; post-EC3, 2.7%; adjusted odds ratio, 0.80; 95% CI, 0.76-0.83; number needed to treat, 179 patient encounters; 95% CI, 149-217).Conclusions and relevanceImplementation of a novel ED-based ICU was associated with improved 30-day survival and reduced inpatient ICU admission. Additional research is warranted to further explore the value of this novel care delivery model in various health care systems.

Dataset Information

Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.

Publications

Duration of withdrawal of life support in the intensive care unit and association with family satisfaction.

Similar Datasets

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