Advances in Clinical and Experimental Medicine

Title abbreviation: Adv Clin Exp Med
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ISSN 1899–5276 (print)
ISSN 2451-2680 (online)
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Advances in Clinical and Experimental Medicine

2019, vol. 28, nr 4, April, p. 541–546

doi: 10.17219/acem/78775

Publication type: original article

Language: English

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Withholding and withdrawing life-sustaining treatment: Experiences in limiting futile therapy from three Polish intensive care departments

Jacek Siewiera1,A,B,C,D,E,F, Dariusz Tomaszewski2,C,D,E,F, Jacek Piechocki2,B,E,F, Andrzej Kübler3,A,E,F

1 Department of Anesthesiology and Intensive Therapy, Military Institute of Medicine, Warszawa, Poland

2 Medical Hyperbaric Center, Warszawa, Poland

3 1st Department of Anesthesiology and Intensive Care, Wroclaw Medical University, Poland

Abstract

Background. In intensive care units (ICUs), a patient’s vital functions may be maintained, regardless of the patient’s chances of survival. A key issue is how to precisely determine the moment in which life-support treatment should be withheld. In many countries, the decision-making process is regulated by the guidelines of scientific societies. However, heuristic errors may influence this process.
Objectives. The objective of this study was to assess factors involved in decisions to implement or withhold treatment in general ICUs in Poland.
Material and Methods. The medical records of patients treated in 3 clinical ICUs of general, cardiosurgical and neurosurgical profile were retrospectively analyzed. Patients with a diagnosis of brain death were finally excluded from the study.
Results. The records of 1,449 patients hospitalized between January 1, 2014 and December 31, 2014 were analyzed. Of these, 226 patient cases were evaluated. There were no correlations between the placement of restrictions on resuscitation in specific cases, use of noradrenaline, frequency of blood gas testing, and patients’ age. There was a relationship between these factors and the duration of hospitalization in the ICU. There was a direct relation between a “do not resuscitate” (DNR) order in a patient’s record and the frequency of both resuscitation procedures and withholding catecholamine treatment in the hours preceding a patient’s death.
Conclusion. Treatment was withheld in about 20% of cases involving dying patients in analyzed ICUs, regardless of age. Placing a limit on treatment consisted of either withholding new procedures or withdrawing existing therapy. The length of stay in the ICU affected the decisions to limit treatment.

Key words

critical care, withholding life-sustaining treatment, withdrawing life-sustaining treatment

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