Limiting life support

Abstract

Different aspects of withholding or withdrawal of life-sustaining treatment have been described in the literature. However, there are few descriptions of local policies or protocols regarding the limiting of life support. The present study describes the pattern of limiting life support in a Scandinavian intensive care unit (ICU) and the experience with a special protocol for such decisions. Prospective study of decisions to limit life support in the ICU of a tertiary referral hospital during 1 year using a special protocol and medical records. A decision to limit life support was documented in the special protocol in 61/1008 (6%) of the patients and in 39/79 (49%) of the patients dying in the ICU. Poor prognosis and failure to respond to treatment were the most common reasons for foregoing life-sustaining treatment. Of the 61 patients with a special protocol, 7 survived more than 3 months. The decision was altered for 5 patients towards additional limitations and for 4 patients towards fewer or no limitations. Decisions to limit life support in the ICU are common. There is a substantial survival rate. A structured clinical protocol can be used for continuous follow-up of decisions and the decision-making process.