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Duration of Withdrawal of Life Support in the Intensive Care Unit and Association with Family Satisfaction

¹ Departments of Internal Medicine and Critical Care, Geneva University Hospitals of Geneva and University of Geneva, Geneva, Switzerland; ² Division of Pulmonary and Critical Care, Department of Medicine, Harborview Medical Center and University of Washington, Seattle, Washington; and ³ Department of Epidemiology, University of Washington, Seattle, Washington

Correspondence and requests for reprints should be addressed to J. Randall Curtis, M.D., M.P.H., Harborview Medical Center, 325 Ninth Avenue, Box 359762, Seattle, WA 98104. E-mail: jrc{at}u.washington.edu

Rationale: Most deaths in the intensive care unit (ICU) involve withholding or withdrawing multiple life-sustaining therapies, but little is known about how to proceed practically and how this process affects family satisfaction.

Objectives: To examine the duration of life-support withdrawal and its association with overall family satisfaction with care in the ICU.

Methods: We studied family members of 584 patients who died in an ICU at 1 of 14 hospitals after withdrawal of life support and for whom complete medical chart and family questionnaires were available.

Measurements and Main Results: Data concerning six life-sustaining interventions administered during the last 5 days of life were collected. Families were asked to rate their satisfaction with care using the Family Satisfaction in the ICU questionnaire. For nearly half of the patients (271/584), withdrawal of all life-sustaining interventions took more than 1 day. Patients with a prolonged (>1 d) 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 (P = 0.037). Extubation before death was associated with higher family satisfaction with care (P = 0.009).

Conclusions: Withdrawal of life support is a complex process that depends on patient and family characteristics. Stuttering withdrawal is a frequent phenomenon that seems to be associated with family satisfaction. Extubation before death should be encouraged if possible.

Key Words: critical care • withdrawal of life support • end-of-life care • palliative care

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject No prior studies have examined the association between the timing of withdrawal of life support and indicators of quality of care. What This Study Adds to the Field This study demonstrates that "stuttering withdrawal" is common in the intensive care unit and associated with family satisfaction with care.