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Int J Crit Illn Inj Sci · Jul 2013
Limiting intensive care therapy in dying critically Ill patients: Experience from a tertiary care center in United Arab Emirates.
- Ur Rahman Masood, Abuhasna Said, Chedid Faris, Mousab Al Mussady, and Amer Al Jundi.
- Department of Critical Care Medicine, Tawam Hospital, P.O. Box 15258, Al Ain, Dubai, United Arab Emirates.
- Int J Crit Illn Inj Sci. 2013 Jul 1;3(3):200-5.
BackgroundLimitations of life-support interventions, by either withholding or withdrawing support, are integrated parts of intensive care unit (ICU) activities and are ethically acceptable. The end-of-life legal aspects and practices in United Arab Emirates ICUs are rarely mentioned in the medical literature. The objective of this study was to examine the current practice of limiting futile life-sustaining therapies in our ICU, modalities for implementing of these decisions, and documentations in dying critically ill patients.Materials And MethodsThis was a retrospective observational study conducted at our ICU. We studied all ICU patients who died from September 2008 to February 2009. Patients' baseline demo-graphics, past medical problems, diagnosis on admission to ICU, and decision to withhold, withdraw and their modalities were collected.MethodsThis was a retrospective observational study conducted at our ICU. We studied all ICU patients who died from September 2008 to February 2009. Patients' baseline demo-graphics, past medical problems, diagnosis on admission to ICU, and decision to withhold, withdraw and their modalities were collected.ResultsThe electronic medical records of 67 patients were reviewed. The commonest method of limiting therapy was no escalation 53.6%. Interventions were withheld in 41.5%. "Do not resuscitate" order was documented in only 16.3%. The commonest method of documenting limitation of therapy was discussion with the family and documenting the prognosis and futility of additional therapy (73.3%). Patients who died early (<48 hrs) compared to patients who died late (>48 hrs) of ICU admission received terminal cardiopulmonary resuscitation more frequently (P < 0.007), had less frequent prognosis documentation (P < 0.009), and had more vasopressors administered (P < 0.006).ConclusionWithholding therapy after discussion with the family was the preferred mode of limiting therapy in a dying patient.
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