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CRITICAL CARE AND TRAUMA

The Practice of and Documentation on Withholding and Withdrawing Life Support: A Retrospective Study in Two Dutch Intensive Care Units

Peter E. Spronk, MD, PhD^*, Alexej V. Kuiper, MSc, Johannes H. Rommes, MD, PhD^*, Joke C. Korevaar, MD, and Marcus J. Schultz, MD, PhD

From the *Department of Intensive Care Medicine, Gelre Hospitals, Location Lukas, Apeldoorn; Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam; HERMES Critical Care Group; and Department of Clinical Epidemiology and Biostatistics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.

Address correspondence and reprint requests to Peter E. Spronk, MD, PhD, FCCP, Department of Intensive Care Medicine, Gelre Hospitals, Location Lukas, PO Box 9014, 7300 DS Apeldoorn, The Netherlands. Address e-mail to p.spronk{at}gelre.nl.

OBJECTIVE: We determined how often life support was withheld or withdrawn in patients who died in the intensive care unit (ICU) or early after ICU discharge and evaluated documentation on decisions regarding these changes in life support orders.

METHODS: This was a retrospective study in a university hospital and a general teaching hospital. Charts of patients who died during ICU stay or within 7 days after ICU discharge in 2005 were reviewed.

RESULTS: Of 2578 admitted patients, 356 patients (14%) died either in the ICU or within 7 days after ICU discharge. For 9 patients data were missing, leaving 347 patients for analysis. Seventy-seven patients (22%) died with full life support, 85 (25%) died while treatment was being withheld, and 185 (53%) patients died while treatment was being withdrawn. One or more changes in life support orders were noted in 266 patients (77%). Only 8% of the patients were recorded to be incapacitated at the time of the change. Patients’ preferences regarding life support were documented in less than one-quarter of cases. In approximately one third of cases, it was not documented which member(s) of the ICU team were involved in an end-of-life decision. In the documented cases, end-of-life decisions were made along with the patient (7%) or with the patient’s representatives (59%).

CONCLUSION: ICU nonsurvivors and patients who die shortly after ICU discharge predominantly die with orders to withhold or withdraw life support. Documentation on the decisions to forgo full life support is poor.

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