Withholding and withdrawing therapy at the intensive care units of the University Hospital of Innsbruck, Austria

Introduction

With increasing technical and medical possibilities, the ICU physician is more often confronted with the situation to withhold (WH) or withdraw (WD) life sustaining treatment in patients with poor prognosis. Apart from the legal situation, the practical management of limiting ICU-therapy continues to be indistinct. Aim of the study was to examine the various procedures as well as the different points of view of intensive care physicians to limit therapy in patients with poor prognosis.

Methods

We interviewed 49 physicians working at 5 different ICUs by a questionnaire about practicing WH and WD of ICU-therapy.

Results

The interviewed physicians gave WH preference over WD. The potential reversibility of disease was estimated more important than the patients own wish in regard to the decision making process. In the sequence to WH or WD, antibiotics and hemodialysis/hemofiltration were mentioned first, ventilation at last. 63% responded to continue, 27% to increase and 10% to reduce sedation and analgesia in case of WH/WD of ICU-therapy. 83% voted for an obligatory DNR-Order in case of WH/WD.

Conclusion

The strategies of the ICU-physicians to WH or WD therapy in critically ill patients were heterogeneous. To establish a more homogenous procedure, it is crucial to establish specific patient orientated guidelines.

Figure

Sequence of WH and WD ICU-therapy in patients with poor prognosis from 1 (first) to 8 (last). These data show the statistical mean value.