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Intensive Care Medicine

, Volume 44, Issue 9, pp 1369–1377 | Cite as

Time-limited trial of intensive care treatment: an overview of current literature

  • Eva E. Vink
  • Elie Azoulay
  • Arthur Caplan
  • Erwin J. O. Kompanje
  • Jan BakkerEmail author
Review

Abstract

In critically ill patients, it is frequently challenging to identify who will benefit from admission to the intensive care unit and life-sustaining interventions when the chances of a meaningful outcome are unclear. In addition, the acute illness not only affects the patients but also family members or surrogates who often are overwhelmed and unable to make thoughtful decisions. In these circumstances, a time-limited trial (TLT) of intensive care treatment can be helpful. A TLT is an agreement to initiate all necessary treatments or treatments with clearly delineated limitations for a certain period of time to gain a more realistic understanding of the patient’s chances of a meaningful recovery or to ascertain the patient’s wishes and values. In this article, we discuss current research on different aspects of TLTs in the intensive care unit. We propose how and when to use TLTs, discuss how much time should be taken for a TLT, give an overview of the potential impact of TLTs on healthcare resources, describe ethical challenges concerning TLTs, and discuss how to evaluate a TLT.

Keywords

Intensive care Critical care Prognosis Outcome Prediction Medical uncertainty 

Notes

Compliance with ethical standards

Conflicts of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature and ESICM 2018

Authors and Affiliations

  • Eva E. Vink
    • 1
    • 2
  • Elie Azoulay
    • 3
  • Arthur Caplan
    • 4
  • Erwin J. O. Kompanje
    • 2
  • Jan Bakker
    • 1
    • 2
    • 5
    • 6
    • 7
    Email author
  1. 1.Department of Pulmonology and Critical Care, Langone Medical Center-Bellevue HospitalNew York UniversityNew YorkUSA
  2. 2.Department of Intensive Care AdultsErasmus MC-University Medical Center RotterdamRotterdamThe Netherlands
  3. 3.Service de Reanimation MedicaleHopital Saint-Louis et Universite Paris 7, Assistance Publique, Hospitaux de ParisParisFrance
  4. 4.Division of Medical Ethics, School of MedicineNew York UniversityNew YorkUSA
  5. 5.Division of Pulmonary, Allergy and Critical Care, University Medical CenterColumbia University College of Physicians and SurgeonsNew YorkUSA
  6. 6.Departamento de Medicina Intensiva, Facultad de MedicinaPontificia Universidad Católica de ChileSantiagoChile
  7. 7.Department of Pulmonary and Critical CareNew York UniversityNew YorkUSA

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