Time-limited trial – searching for rational solutions in the functioning of intensive care units

Abstract

Introduction:Evaluating futility carries the burden of subjectivity; we do not have scales that verify the impartiality of decisions. It is very difficult to decide on the fate of a patient who shows up intubated at the intensive care unit (ICU). The uncertainty of the prognosis at the beginning of a critical illness does not allow the doctor to predict the effect of therapy in terms of survival, regaining the previous quality of life, and independent functioning. Material and methods:There are 3 options to choose from: ICU admission and all invasive procedures; refusal of ICU admission, with a sense of making decisions based on incomplete information; and a time-limited trial, which allows testing invasive procedures aimed at the potential improvement of the patient's health and the reassessment of gains and losses after a specific, defined period. It seems that the last solution is fair and acceptable to the patient/family and medics.Results: A time-limited trial is part of the concept of personalized medicine, which puts the patient at the centre of our actions. A time-limited trial is a practical proposition for patients with a doubtful prognosis and uncertainty concerning the effects of invasive and aggressive therapies. Conclusions:Patients with a limited life expectancy and exhausted physiological reserves are ideal candidates for the implementation of the described method.