Objectives: To examine the withdrawal process in the ICU and compare the perceptions of withdrawal among health care providers (physicians, nurses, and respiratory therapists) involved in the withdrawal process.
Design: A descriptive survey conducted at two points in time, in 1998 (time 1) and in 2001 (time 2).
Setting and sample: A 24-bed multidisciplinary ICU of a university-affiliated hospital in Wisconsin served as the setting. Convenience sampling was used to include voluntary participants who were regularly involved in withdrawal in the ICU. At time 1, fourteen nurses, 7 physicians, and 10 respiratory therapists participated. Twenty-two nurses, 6 physicians, and 9 respiratory therapists were included at time 2.
Method: Perceptions of health care providers about the preferred order of withdrawal of life sustaining treatments, the frequency of withdrawal discussions, and perceptions regarding how withdrawal of mechanical ventilation actually occurred were measured.
Findings: Physicians and nurses preferred hemodialysis and blood products as treatments to be withdrawn first while respiratory therapists preferred antibiotics and Total Parenteral Nutrition to be withdrawn first. All three groups felt that they had withdrawal discussions with the family majority of the time. Significant disagreement about physician?s responsibilities during withdrawal of mechanical ventilation existed among the three groups. Physicians reported higher frequencies of their initial and continued presence during withdrawal than what the nurses and respiratory therapists perceived. Although most physicians perceived that they actively participated in the sedation and extubation of the patients, the nurses and respiratory therapists did not feel the same. Contrary to the perceptions of nurses and respiratory therapists, most physicians reported that they were performing baseline sedation and benzodiazepam administration for withdrawal patients. More than 70 % of the participants reported that EKG and O2 saturation were monitored always or a majority of time regardless of the patient status.
Conclusions: There was a lack of consensus among health care providers about perceptions of the withdrawal process and the sequence of withdrawal of life sustaining treatments. The variability in the process of withdrawal without clarification and agreement on responsibility may cause unnecessary differences and conflicts. Disagreement within the ICU team could create confusion for the family in withdrawal decision-making.
Implications: The findings are helpful to understand health care providers? perceptions of the withdrawal process in the ICU. There should be clear prior discussion among the ICU team members regarding the method of withdrawal, sedation, and extubation responsibilities. More efforts are also needed to provide comfortable and peaceful environments for the dying patient and family during the withdrawal process.
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