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Intensive Care Medicine
Published in: Intensive Care Medicine 6/2016

01-06-2016 | Original

Guidelines for the withdrawal of life-sustaining measures

Authors: James Downar, Jesse W. Delaney, Laura Hawryluck, Lisa Kenny

Published in: Intensive Care Medicine | Issue 6/2016

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Abstract

Background

Withdrawal of life-sustaining measures is a common event in the intensive care unit yet it involves a complex balance of medical, legal and ethical considerations. Very few healthcare providers have been specifically trained to withdraw life-sustaining measures, and no comprehensive guidelines exist to help ensure clinicians deliver the highest quality of care to patients and families. Hence, we sought to develop guidelines for the process of withdrawing life-sustaining measures in the clinical setting.

Methods

We convened an interdisciplinary group of ICU care providers from the Canadian Critical Care Society and the Canadian Association of Critical Care Nurses, and used a modified Delphi process to answer key clinical and ethical questions identified in the literature.

Results

A total of 39 experienced clinicians completed the initial workshop, and 36 were involved in the subsequent Delphi rounds. The group developed a series of guidelines to address (1) preparing for withdrawal of life-sustaining measures; (2) assessment of distress; (3) pharmaceutical management of distress; and (4) discontinuation of life-sustaining measures and monitoring. The group achieved consensus on all aspects of the guidelines after the third Delphi round.

Conclusion

We present these guidelines to help physicians provide high-quality end of life (EOL) care in the ICU. Future studies should address their effectiveness from both critical care team and family perspectives.
Appendix
Available only for authorised users
Footnotes
1
An additional recommendation regarding neuromuscular blockade has been removed from these guidelines but appears in an online supplement.
 
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Metadata
Title
Guidelines for the withdrawal of life-sustaining measures
Authors
James Downar
Jesse W. Delaney
Laura Hawryluck
Lisa Kenny
Publication date
01-06-2016
Publisher
Springer Berlin Heidelberg
Published in
Intensive Care Medicine / Issue 6/2016
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI
https://doi.org/10.1007/s00134-016-4330-7

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