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Intensive Care Medicine
Published in: Intensive Care Medicine 9/2004

01-09-2004 | Original

Clinician discomfort with life support plans for mechanically ventilated patients

Authors: Lauren Griffith, Deborah Cook, Steven Hanna, Graeme Rocker, Peter Sjokvist, Peter Dodek, John Marshall, Mitchell Levy, Joseph Varon, Simon Finfer, Roman Jaeschke, Lisa Buckingham, Gordon Guyatt, for the Level of Care Investigators and the Canadian Critical Care Trials Group

Published in: Intensive Care Medicine | Issue 9/2004

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Abstract

Objective

To examine the incidence and predictors of clinician discomfort with life support plans for ICU patients.

Design and setting

Prospective cohort in 13 medical-surgical ICUs in four countries.

Patients

657 mechanically ventilated adults expected to stay in ICU at least 72 h.

Measurements and results

Daily we documented the life support plan for mechanical ventilation, inotropes and dialysis, and clinician comfort with these plans. If uncomfortable, clinicians stated whether the plan was too technologically intense (the provision of too many life support modalities or the provision of any modality for too long) or not intense enough, and why. At least one clinician was uncomfortable at least once for 283 (43.1%) patients, primarily because plans were too technologically intense rather than not intense enough (93.9% vs. 6.1%). Predictors of discomfort because plans were too intense were: patient age, medical admission, APACHE II score, poor prior functional status, organ dysfunction, dialysis in ICU, plan to withhold dialysis, plan to withhold mechanical ventilation, first week in the ICU, clinician, and city.

Conclusions

Clinician discomfort with life support perceived as too technologically intense is common, experienced mostly by nurses, variable across centers, and is more likely for older, severely ill medical patients, those with acute renal failure, and patients lacking plans to forgo reintubation and ventilation. Acknowledging the sources of discomfort could improve communication and decision making
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Metadata
Title
Clinician discomfort with life support plans for mechanically ventilated patients
Authors
Lauren Griffith
Deborah Cook
Steven Hanna
Graeme Rocker
Peter Sjokvist
Peter Dodek
John Marshall
Mitchell Levy
Joseph Varon
Simon Finfer
Roman Jaeschke
Lisa Buckingham
Gordon Guyatt
for the Level of Care Investigators and the Canadian Critical Care Trials Group
Publication date
01-09-2004
Publisher
Springer-Verlag
Published in
Intensive Care Medicine / Issue 9/2004
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-004-2360-z

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