Treatment withdrawal and acute brain injury: an integral part of care

Smith, Martin

doi:10.1111/j.1365-2044.2012.07304.x

Cited by 15 publications

(12 citation statements)

References 37 publications

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“…In Norway, the law provides physicians with decision-making authority for patients who lacks capacity [1]. Deciding when to continue, limit or withdraw life-sustaining treatment is an integral part of attending physicians’ responsibility [2–4]. Prolonged treatment may be assessed as futile immediately after the initial medical assessments, or futility may be recognized days, weeks or months after injury.…”

Section: Introductionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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BackgroundTreatment-limiting decisions (TLD) for severe traumatic brain injury (sTBI) have been sparsely studied. This study determine prevalence, main reason for, categories and timing of TLDs in a Norwegian regional trauma setting.MethodsA retrospective study of a 2-year cohort of 579 sTBI patients admitted to Oslo University Hospital (OUH). Prospectively collected data in the OUH Trauma Registry were combined with retrospective data from a chart review regarding TLDs.ResultsTLDs were documented for 101/579 sTBI patients (17%). The situation was evaluated as futile in 59 cases and as potentially inappropriate in 42 cases. The three most frequent types of TLDs were withholding of neurosurgery, do not resuscitate orders and withdrawing of organ support. In 70% of cases, the first TLD was made within 2 days after injury, while in 14%, the first TLD was made later than day 7. Twenty percent (20/101) of the first TLDs were later adjusted, revoked in 4 patients and broadening of TLDs in 16 patients. The median time from the decision to death was 2 days (range 1–652). TLDs were documented in 93% of in-hospital death cases (n = 79). In-hospital deaths occurred in 73% of TLD group cases and 1% of non-TLD group cases. Family interaction and multi-team discussions were documented in >88% of cases, but no advanced directives were found, and notifications of patients’ preferences were found in only 7% of cases.DiscussionClinicians should consider limiting treatment if continued treatment is not in the patients best interest. A range of different types of TLDs were applied for patients after sTBI in the trauma hospital setting.ConclusionTLDs were found in 17% of sTBI patients. Value considerations behind TLDs in this care context need to be further explored.

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Section: Introductionmentioning

confidence: 99%

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Robertsen

Førde

Skaga

et al. 2017

Scand J Trauma Resusc Emerg Med

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“…In most cases of mortality, death occurs after withdrawal of life-sustaining interventions, primarily mechanical ventilation, based on the perception that the prognosis for a favorable neurological recovery is poor [57][58][59]. If the best possible functional or cognitive outcome is one that would not be acceptable to a patient, then withdrawal of life-sustaining interventions may be entirely appropriate and necessary [61]. If the best possible functional or cognitive outcome is one that would not be acceptable to a patient, then withdrawal of life-sustaining interventions may be entirely appropriate and necessary [61].…”

Section: Length Of Stay and Withdrawal Of Life-sustaining Interventionsmentioning

confidence: 99%

Neurocritical care

Kramer

Zygun

2014

Current Opinion in Critical Care

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“…Clinicians who have adopted DCD will acknowledge that the greater the stabilization of the patient over time, the lower the likelihood of death within a short timeframe after withdrawal of ventilatory support, and calls for intensivists to embrace withdrawal of support decisions are not without conflict of interest, particularly if organ donation is simultaneously advocated [27]. The most challenging component of this initiative, however, from an ethical and legal perspective relates to the withdrawal process itself.…”

Section: Contentious Areas For Critical Care: Organ Donationmentioning

confidence: 99%

The ethics of hastening death during terminal weaning

Walton¹,

Bell²

2013

Current Opinion in Critical Care

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The process and, therefore, the timing of dying is open to manipulation by intensivists, families, other hospital physicians, courts of law and extraneous influences such as organ donation. Intensivists faced with these challenging processes need to consider some key principles to help them navigate the management of dying. They need to demonstrate transparency in order to engender trust, be responsive to the dynamically evolving needs of patient and family, avoid ambiguity, show consistency and predictability and, finally, they need to conform with society's expectations and professional standards to achieve defensibility for their actions. Adherence to these principles is likely to minimize conflict, maximize patient benefit, maintain public confidence and avoid professional jeopardy.

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Treatment withdrawal and acute brain injury: an integral part of care

Cited by 15 publications

References 37 publications

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Treatment-limiting decisions in patients with severe traumatic brain injury in a Norwegian regional trauma center

Neurocritical care

The ethics of hastening death during terminal weaning

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