Most deaths in intensive care units occur after decisions to limit or withdraw life
support [
1
,
2
]. Despite an extensive literature on whether to withdraw life support, little attention has been given to how to withdraw it [
3
,
4
]. For example, a recent edition of a critical care textbook exhaustively covers the
ethical and legal aspects of life-support withdrawal, but makes no recommendations
for carrying it out [
]. Only recently, in the wake of growing data that problems may exist in providing
palliative care in the intensive care unit (ICU), has attention been directed to the
practical aspects of withdrawing life support [
6
,
7
,
8
]. Many practical questions about withdrawal of life support, and specifically about
the withdrawal of mechanical ventilation, are perplexing and controversial: Should
the endotracheal tube be left in place? Should the ventilator be weaned slowly or
quickly? When and how should sedation be increased? How can the concerns about relieving
suffering be reconciled with fears of killing the patient? Should neuromuscular blockade
be discontinued? These questions are important because clinicians face them frequently
and are still confused by the goals and process of withdrawing life support, and because
patients who die after withdrawal of life support may receive inadequate pain and
symptom management [
9
,
10
].To read this article in full you will need to make a payment
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Treece P.D., Engelberg R.A., Crowley L., et al. Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med 2004; in press
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