Withdrawal of life support often stepwise

NEW YORK (Reuters Health) - Rather than being an abrupt action, withdrawal of life support often occurs in a sequential or “stuttering” fashion over a period of time, such that the whole process takes longer than a day, according to a new study.

Once someone is determined to be brain dead, there is no medical reason to prolong life support. Nonetheless, “We found that sequential withdrawal of life support is not as rare a phenomenon as previously believed,” Dr. J. Randall Curtis, from the University of Washington in Seattle, said in a statement. “It occurred in nearly half of the patients we studied.”

The findings, reported in the American Journal of Respiratory and Critical Care Medicine, indicate that this approach may be taken so that families can be more prepared.

The study involved an analysis of medical records and family questionnaires for 584 patients who died in an ICU after withdrawal of life support.

For 271 of the patients, the withdrawal of life support took longer than a day, the report indicates.

Compared with patients who had a shorter withdrawal period, these patients were younger, had longer ICU stays, were less likely to have cancer, and had more decision-makers involved.

Family satisfaction with the care the patient received tied in with a longer duration of life-support withdrawal.

“The ‘take home’ message is not to prolong the withdrawal of life-sustaining therapies to the possible detriment of the patient, but to facilitate better communications between ICU clinicians and patients’ families,” Dr. Curtis emphasized.

“When physicians make a decision to withdraw support, they have often not prepared the family sufficiently,” he explained, “and physicians may consequently embark on ’stuttering’ withdrawal of life support in order to have more time to prepare the family.”

SOURCE: American Journal of Respiratory and Critical Care Medicine, October 2008.

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