Decisions to withhold or withdraw life-sustaining treatment in a Norwegian intensive care unit

作者：Hoel H; Skjaker S A; Haagensen R; Stavem K^*

来源：Acta Anaesthesiologica Scandinavica, 2014, 58(3): 329-336.

DOI：10.1111/aas.12246

<jats:sec><jats:title>Background</jats:title><jats:p>To withhold and withdraw treatment are important and difficult decisions made in the intensive care unit (<jats:styled-content style="fixed-case">ICU</jats:styled-content>). The aim of this study was to investigate the incidence of withholding or withdrawing treatment, characteristics of the patients, and how these decision processes were handled and documented in a general <jats:styled-content style="fixed-case">ICU</jats:styled-content> from 2007 to 2009 in a university hospital in <jats:styled-content style="fixed-case">N</jats:styled-content>orway.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Patient characteristics and outcomes of treatment were prospectively registered. We retrospectively reviewed the medical records for information on limitations in treatment.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>In total, 1287 patients were admitted to the <jats:styled-content style="fixed-case">ICU</jats:styled-content>. The <jats:styled-content style="fixed-case">ICU</jats:styled-content> mortality was 208 (16%), and the hospital mortality was 341 (26%). In total, 301 patients (23%) had treatment withheld or withdrawn. Medical and unscheduled surgical patients with limitations in treatment had higher <jats:styled-content style="fixed-case">S</jats:styled-content>implified <jats:styled-content style="fixed-case">A</jats:styled-content>cute <jats:styled-content style="fixed-case">P</jats:styled-content>hysiology <jats:styled-content style="fixed-case">S</jats:styled-content>core <jats:styled-content style="fixed-case">II</jats:styled-content> (<jats:italic>P</jats:italic> &lt; 0.001) and were older (<jats:italic>P</jats:italic> &lt; 0.001) than those without limitations in treatment. The most common main reason for withdrawing treatment was poor prognosis. According to the medical records, the patient was involved in the decision‐making regarding withdrawal of treatment in only 2% of the cases, and the patient's relatives were involved in the decision‐making in 77% of the cases. In 12% of the cases, type of treatment withdrawn was not documented.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>Withholding or withdrawing treatment in the <jats:styled-content style="fixed-case">ICU</jats:styled-content> was common. Medical and unscheduled surgical patients with limitations in treatment were older and more severely ill than patients without limitations. There is a potential for better documentation of the processes regarding withholding or withdrawing life‐sustaining intensive care treatment.</jats:p></jats:sec>

• 出版日期2014-3