Withdrawal/Withholding of Life-Sustaining Therapies in the Intensive Care Unit

Abstract

Limitations of life-sustaining therapies in the Intensive Care Unit (ICU) are usually applied when therapeutic measurements are considered futile. Withholding and withdrawal therapies are then applied because therapies cannot achieve the desired outcomes. When implemented, several aspects should be taken into consideration, such as cultural, sociological, or personal preferences regarding end-of-life care. Withholding is the decision not to start or increase a treatment if the benefit is not clear, and is the most common measure applied, including orders such as do-notresuscitate, do-not-intubate, or non-renal-replacement therapies. Withdrawal is a less frequent approach, and it is defined as the decision to stop a treatment. Decisionmaking should be multidisciplinary and consensual. It must respect the wishes of the patient and/or their relatives. These decisions usually carry a substantial emotional burden, especially for healthcare professionals, who might consider limitation of life-sustaining therapies as a failure, even though this perception should evolve. In addition, the implementation of these measures may lead to stressful situations for professionals, which need to be addressed to avoid a negative impact. Mortality is the most common outcome that emerges from the use of these measures. However, a significant number of patients survive to hospitalization. Survival can have consequences that may affect the patient’s subsequent quality of life. Due to the potential concerns, the difficulty of implementation, and the challenges in the decision-making process, communication between healthcare professionals, patients, and families/ relatives is an important issue when it comes to limiting life-sustaining therapies.