What is the influence of critical care physicians in abandoning the life support of patients with brain injury?

Decisions to discontinue life-sustaining treatments in patients with severe brain damage are complex, rely on many factors and are usually taken by ICU physicians and families from the unit. intensive care. A study in CMAJ (Journal of the Canadian Medical Association) provides a new understanding of decision-making processes for this patient population, responsible for most hospital deaths due to trauma.

"Many clinicians find it difficult to make recommendations for stopping life-sustaining treatments because of the uncertainty of matching the views of the family or caregiver as to what they would have liked to see. patient in terms of quality of life and Alexis Turgeon, intensive care physician and researcher at the Research Center of the CHU de Québec – Université Laval and Canada Research Chair in Neurology of Critical Care and Traumatology at Laval University , in Quebec City, Quebec.

Most deaths in patients with severe traumatic brain injury occur after the decision to stop life-sustaining treatments. This patient population differs from the general intensive care unit (ICU) population, as most patients were in good health before being admitted to the ICU, compared to older patients whose quality of life may be lower. -be already lower because of a pre-existing condition. As a result, decisions to withdraw life-sustaining treatments are made differently, primarily on the basis of a long-term prognosis and quality of life.

The researchers conducted a qualitative descriptive study of interviews with critical care physicians from across Canada to understand the factors that determine a critical care physician's decision to discuss with families the withdrawal of maintenance-seeking treatments. life in patients with severe traumatic brain injury. The results show that several factors are involved, including the patient's pre-expressed wishes and family wishes, the severity and location of the injury, as well as the evidence. Past experience of physicians, legislation, opinions of colleagues and time are additional factors influencing decisions. The incidence of withdrawal of life sustaining and death treatments in critically ill patients with traumatic brain injury varies from one hospital to another.

"The influence of the patient and family situation is an important factor in physician decision-making," said Dr. Turgeon. "It's rebaduring, but difficult when the patient's prognosis is uncertain."

Better evidence, tools to help predict outcomes for patients, standardization, better ways to integrate patient values ​​and preferences into the decision-making process, better training during intensive care fellowships and more time to badess the prognosis are elements that could improve decision-making. life-sustaining treatments.

"Our study has implications for the care of critically ill patients with traumatic brain injury, and we hope this will inform policy to improve how critical care physicians determine the prognosis and level of care decisions with families, "said Dr. Turgeon.