Abstract：
OBJECTIVE:The process of controlled donation after circulatory death (cDCD) is strongly connected with the process of withdrawal of life-sustaining therapy. In addition to impacting cDCD success, actions comprising withdrawal of life-sustaining therapy have implications for quality of palliative care. We examined pilot study data from Canadian intensive care units to explore current practices of life-sustaining therapy withdrawal in nondonor patients and described variability in standard practice. DESIGN:Secondary analysis of observational data collected for Determination of Death Practices in Intensive Care pilot study. SETTING:Four Canadian adult intensive care units. PATIENTS:Patients ≥18 years in whom a decision to withdraw life-sustaining therapy was made and substitute decision makers consented to study participation. Organ donors were excluded. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Prospective observational data on interventions withdrawn, drugs administered, and timing of life-sustaining therapy withdrawal was available for 36 patients who participated in the pilot study. Of the patients, 42% died in ≤1 hour; median length of time to death varied between intensive care units (39-390 minutes). Withdrawal of life-sustaining therapy processes appeared to follow a general pattern of vasoactive drug withdrawal followed by withdrawal of mechanical ventilation and extubation in most sites but specific steps varied. Approaches to extubation and weaning of vasoactive drugs were not consistent. Protocols detailing the process of life-sustaining therapy withdrawal were available for 3 of 4 sites and also exhibited differences across sites. CONCLUSIONS:Standard practice of life-sustaining therapy withdrawal appears to differ between selected Canadian sites. Variability in withdrawal of life-sustaining therapy may have a potential impact both on rates of cDCD success and quality of palliative care.
journal_name
J Intensive Care Medjournal_title
Journal of intensive care medicineauthors
van Beinum A,Hornby L,Ramsay T,Ward R,Shemie SD,Dhanani Sdoi
10.1177/0885066615571529subject
Has Abstractpub_date
2016-05-01 00:00:00pages
243-51issue
4eissn
0885-0666issn
1525-1489pii
0885066615571529journal_volume
31pub_type
杂志文章abstract：:Cardiomyopathy secondary to toxic shock syndrome (TSS) is an uncommon but potentially life-threatening problem. We report the case of a 51-year-old male who presented with profound cardiogenic shock and multiorgan failure that could not be managed by conventional therapy with intravenous fluids, vasopressors and inotr...
journal_title：Journal of intensive care medicine
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journal_title：Journal of intensive care medicine
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journal_title：Journal of intensive care medicine
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abstract：:Cardiac transplantation has now become accepted therapy for the treatment of end-stage heart disease in both children and adults, and literally thousands of patients are bearers of cardiac grafts. Because of these patients' susceptibility to infections, rejection, coronary disease, and malignancy, as well as to serio...
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journal_title：Journal of intensive care medicine
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更新日期：2013-09-01 00:00:00
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journal_title：Journal of intensive care medicine
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更新日期：2011-09-01 00:00:00
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更新日期：2008-07-01 00:00:00
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journal_title：Journal of intensive care medicine
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更新日期：2015-02-01 00:00:00
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更新日期：2015-07-01 00:00:00
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journal_title：Journal of intensive care medicine
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更新日期：2018-08-01 00:00:00
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journal_title：Journal of intensive care medicine
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journal_title：Journal of intensive care medicine
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journal_title：Journal of intensive care medicine
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更新日期：2016-07-01 00:00:00
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更新日期：2019-01-01 00:00:00
