Canadian Journal of Anesthesia

, Volume 53, Issue 8, pp 814–819

Brief review: Practice variation in end of life care in the ICU: implications for patients with severe brain injury

  • Graeme M. Rocker
  • Deborah J. Cook
  • Sam D Shemie
Neuroanesthesia and Intensive Care

Abstract

Purpose

To review end of life care issues in the intensive care unit (ICU) and how practice variation might affect the ultimate outcome of acute brain injury.

Sources

Bibliographic literature search and personal files.

Findings

In Canada, 10-20% of critically ill adults die in the ICU. Many of these deaths follow acute brain injury in the setting of clinical deterioration, life support limitation and brain death. This brief review addresses some key elements of end of life care for critically ill brain injured patients, including family interactions, making survival predictions, and factors influencing decision-making about cardiopulmonary resuscitation and withdrawal of mechanical ventilation.

Conclusions

Provision of compassionate high quality end of life care should be standard of practice for brain injured and all other critically ill patients who cannot survive. Inconsistencies in end of life care may affect where, when and how patients die, the quality of their death and whether or not they are considered for organ and tissue donation.

Revue sommaire de la variation des soins aux mourants dans les USI : implications pour les patients atteints de lésion cérébrale sévère

Résumé

Objectif

Revoir la question des soins aux mourants dans les unités de soins intensifs (USI) et la façon dont les différentes pratiques peuvent modifier l’étape finale d’une lésion cérébrale aiguë. Sources : Une recherche bibliographique des documents et des dossiers personnels.

Constatations

Au Canada, 10-20 % des adultes gravement malades meurent à l’USI. Beaucoup de ces décès suivent une lésion cérébrale aiguë dans le contexte d’une détérioration clinique, une limitation du maintien des fonctions vitales et une mort encéphalique. Notre revue aborde certains éléments clés des soins aux mourants, qui ont de graves lésions cérébrales, dont les interactions avec la famille, les prédictions de survie et les facteurs qui influencent les décisions sur la réanimation cardiorespiratoire et le retrait de la ventilation mécanique.

Conclusion

Des soins de fin de vie de grande qualité, prodigués avec compassion, devraient être la norme de pratique pour les patients atteints de lésions cérébrales et de toute autre maladie grave. Le manque de cohérence des soins aux mourants peut modifier les circonstances et la qualité de leur mort et leur reconnaissance comme donneurs d’organes et de tissu.

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Copyright information

© Canadian Anesthesiologists 2006

Authors and Affiliations

  • Graeme M. Rocker
    • 1
  • Deborah J. Cook
    • 2
  • Sam D Shemie
    • 3
  1. 1.Department of MedicineDalhousie UniversityHalifaxCanada
  2. 2.Departments of Medicine & Clinical Epidemiology & BiostatisticsMcMaster UniversityHamilton
  3. 3.Division of Pediatric Critical CareMontreal Children’s Hospital, McGill University Health CentreMontrealCanada

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