Research Reports - Factors associated with the withdrawal of life-sustaining therapies in patients with severe traumatic brain injury

Neurocrit Care. 2012 Oct 26

Côte N, Turgeon AF, Lauzier F, Moore L, Scales DC, Bernard F, Zarychanski R, Burns KE, Meade MO, Zygun D, Simard JF, Boutin A, Brochu JG, Fergusson DA

PURPOSE: To identify factors associated with decisions to withdraw
life-sustaining therapies in patients with severe traumatic brain injury (TBI).
MATERIALS AND METHODS: We conducted a 2-year multicenter retrospective cohort
study (2005-2006) in mechanically ventilated patients aged 16 years and older
admitted to the intensive care units (ICUs) of six Canadian level I trauma
centers following severe TBI. One hundred and twenty charts were randomly
selected at each center (n = 720). Data on ICU management strategies, patients'
clinical condition, surgical procedures, diagnostic imaging, and decision to
withdraw life-sustaining therapies were collected. The association of factors
pertaining to the injury, interventions, and management strategies with decisions
to withdraw life-sustaining therapies was evaluated among non-survivors. RESULTS:
Among the 228 non-survivors, 160 died following withdrawal of life-sustaining
therapies. Patients were predominantly male (69.7 %) with a mean age of 50.7
(±21.7) years old. Brain herniation was more often reported in patients who died
following decisions to withdraw life-sustaining therapies (odds ratio [OR] 2.91,
95 % confidence interval [CI] 1.16-7.30, p = 0.02) compared to those who died due
to other causes (e.g., cardiac arrest, shock, etc.). Epidural hematomas (OR 0.18,
95 % CI 0.06-0.56, p < 0.01), craniotomies (OR 0.12, 95 % CI 0.02-0.68,
p = 0.02), and other non-neurosurgical procedures (OR 0.08, 95 % CI 0.02-0.43,
p < 0.01) were less often associated with death following withdrawal of
life-sustaining therapies than death from other causes. CONCLUSIONS: Death
following decisions to withdraw life-sustaining therapies is associated with
specific patient and clinical factors, and the intensity of care.

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