Decisions to withhold or withdraw life-sustaining treatment in a Norwegian intensive care unit

Abstract

Background: To withhold or withdraw therapies are important decisions made in intensive care units (ICUs). The aim of this study was to investigate the incidence of withholding or withdrawing therapy, what characterizes the patients and how these decision processes are handled in a general ICU in a University Hospital in Norway, from 2007 to 2009.

Methods: Age, sex, reason for admission to the ICU, length of stay, diagnostic category, Simplified Acute Physiology Score II (SAPS II), invasive mechanical ventilation time, outcome of stay and if therapy was withheld or withdrawn, were prospectively registered in a database. For this study we retrospectively reviewed the medical records for all information on limitations in therapy.

Results: In total, 1287 patients were admitted to the ICU, and 72% received mechanical ventilation. ICU mortality was 208 (16%), and 341 (26%) died before hospital discharge. In total, 301 patients (23%) had limitations in therapy and higher in-hospital mortality than the 986 patients without limitations (79% vs. 11%, p<0.001). Patients with limitations in therapy had higher SAPS II (p<0.001) and were older (p<0.001) than those without limitations. The incidence of limitations in therapy differed among the diagnostic categories (p<0.001). The most common argument for withdrawing therapy was poor prognosis. In 87% of the cases with withdrawal of therapy a consultant physician was documented as responsible for the decision.

Conclusion: Withholding or withdrawing therapy in the ICU was common. The patients with limitations in therapy were older and had more severe illnesses than patients with no limitations. Consultant physicians made the decision in most cases.