Withdrawal of intensive care in the patient's home

Death should be managed as vigorously as life saving. Historically intensive therapy is withdrawn in the intensive care unit, but we would like to present four cases where intensive care treatment was withdrawn at home. The staff of the Intensive Care Unit at Middlemore Hospital have taken four patients home, on ventilarory and inotropic support, and withdrawn care when the patient was settled in their home, surrounded by family. This is felt to aid in the grieving process, and in many cases is culturally desirable. The cases thus far are subarachnoid haemorrhage, massive intracerbral bleed and intractable septic shock. From our experience we recommend that certain selection criteria are observed. There is a need for the patient and family to live locally, support is required from the local general practitioner and district nursing service, and a clear explanation of the whole process must be understood by all family members prior to leaving the intensive care unit. A palliation plan must be commenced prior to leaving the intensive care unit.

We see this as a practical option in selected intensive care patients.