Withdrawal and withholding of life support in the intensive care unit : A comparison of teaching and community hospitals.
To compare the incidence of withdrawal or withholding of life support (WD/WHLS), and to identify similarities and differences in the process of the withdrawal of life support (WDLS) between teaching and community hospitals'intensive care units (ICUs).
Prospective cohort study, with some data obtained by retrospective chart review.
The ICUs of three teaching hospitals and six community hospitals.
All patients who died in these nine ICUs over a 6-mo period.
Measurements and Main Results
Data on admitting diagnosis, cause of death, mode of death (death despite active treatment, withdrawal or withholding of life support), those initiating and involved in WDLS, and modalities of life support withdrawn were gathered for patients dying in the ICU over a 6-mo period.
One hundred sixty patients in community hospitals and 292 in teaching hospitals died in their respective ICUs over the 6-mo period.
We found a difference in the distribution of mode of death between community hospitals and teaching hospitals, resulting from a greater proportion of patients dying as a result of withholding life support in community hospitals (11.9% vs. 3.8% withheld, respectively, p=004).
Among the six community hospitals and three teaching hospitals, we found a difference in the proportion of patients dying despite active treatment compared with those dying as a result of WD/WHLS (p=042 and p=044, respectively). (...)
Mots-clés Pascal : Unité soin intensif, Centre hospitalier universitaire, Hôpital général, Malade état grave, Stade terminal, Euthanasie, Critère décision, Prise décision, Arrêt traitement, Refus, Canada, Amérique du Nord, Amérique, Etude comparative, Incidence, Epidémiologie, Adulte, Homme, Ethique
Mots-clés Pascal anglais : Intensive care unit, Teaching hospital, General hospital, Critically ill, Terminal stage, Euthanasia, Decision criterion, Decision making, Withdrawal, Denial, Canada, North America, America, Comparative study, Incidence, Epidemiology, Adult, Human, Ethics
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0138861
Code Inist : 002B31. Création : 21/07/1998.