Sequential Withdrawal of Life Support Prepares Families Better

A new study reports that in cases of life-support withdrawal, overall family satisfaction with care in the ICU was higher when the withdrawal process was prolonged.
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Researchers from the University of Washington (UW; Seattle, WA, USA) and the University of Geneva (Switzerland) studied family members of 584 patients who died in an intensive care unit (ICU) after withdrawal of life support, and for whom complete medical chart and family questionnaires were available. The data concerning six life-sustaining interventions administered during the last 5 days of life were collected, and the families were asked to rate their satisfaction with care using the Family Satisfaction in the ICU questionnaire.

The study results showed that for nearly half of the patients (271 out of 584), withdrawal of all life-sustaining interventions took more than one day. Patients with a prolonged 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. Extubation of the patient before death, in particular, was associated with higher family satisfaction with care. The study was published in the October 15, 2008, issue of the American Journal of Respiratory and Critical Care Medicine.

"The 'take home' message is not to prolong the withdrawal of life-sustaining therapies to the possible detriment of the patient, but to facilitate better communications between ICU clinicians and patients' families,” said senior author J. Randall Curtis, M.D., M.P.H., a professor in the division of pulmonary and critical care at UW. "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.”

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University of Washington
University of Geneva