naa a22 4500 510799957 CHVBK 20180411083350.0 cr unu---uuuuu 180411e20130201xx s 000 0 eng 10.1007/s12028-012-9787-9 doi (NATIONALLICENCE)springer-10.1007/s12028-012-9787-9 Factors Associated with the Withdrawal of Life-Sustaining Therapies in Patients with Severe Traumatic Brain Injury: A Multicenter Cohort Study [Elektronische Daten] [Nicolas Côte, Alexis Turgeon, François Lauzier, Lynne Moore, Damon Scales, Francis Bernard, Ryan Zarychanski, Karen Burns, Maureen Meade, David Zygun, Jean-François Simard, Amélie Boutin, Jacques Brochu, Dean Fergusson] 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 16years 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. Springer Science+Business Media New York, 2012 Withdrawal of life-sustaining therapy nationallicence Mortality nationallicence Traumatic brain injury nationallicence Risk factors nationallicence End-of-life nationallicence Côte Nicolas Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut Turgeon Alexis Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut Lauzier François Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut Moore Lynne Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l'Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit), Université Laval, 1401, 18e rue, Local H-012a, G1J 1Z4, Quebec, QC, Canada aut Scales Damon Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada aut Bernard Francis Department of Internal Medicine, Université de Montréal, Montreal, QC, Canada aut Zarychanski Ryan Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada aut Burns Karen Department of Critical Care Medicine, St-Michael's Hospital, University of Toronto, Toronto, ON, Canada aut Meade Maureen Department of Critical Care Medicine, McMaster University, Hamilton, ON, Canada aut Zygun David Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada aut Simard Jean-François Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l'Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit), Université Laval, 1401, 18e rue, Local H-012a, G1J 1Z4, Quebec, QC, Canada aut Boutin Amélie Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l'Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit), Université Laval, 1401, 18e rue, Local H-012a, G1J 1Z4, Quebec, QC, Canada aut Brochu Jacques Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut Fergusson Dean Clinical Epidemiology Unit, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada aut Neurocritical Care Humana Press Inc 18/1(2013-02-01), 154-160 1541-6933 18:1<154 2013 18 12028 https://doi.org/10.1007/s12028-012-9787-9 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-012-9787-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Côte Nicolas Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Turgeon Alexis Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Lauzier François Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Moore Lynne Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l'Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit), Université Laval, 1401, 18e rue, Local H-012a, G1J 1Z4, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Scales Damon Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Bernard Francis Department of Internal Medicine, Université de Montréal, Montreal, QC, Canada aut NATIONALLICENCE 700 1- Zarychanski Ryan Department of Internal Medicine, Section of Critical Care Medicine, University of Manitoba, Winnipeg, MB, Canada aut NATIONALLICENCE 700 1- Burns Karen Department of Critical Care Medicine, St-Michael's Hospital, University of Toronto, Toronto, ON, Canada aut NATIONALLICENCE 700 1- Meade Maureen Department of Critical Care Medicine, McMaster University, Hamilton, ON, Canada aut NATIONALLICENCE 700 1- Zygun David Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada aut NATIONALLICENCE 700 1- Simard Jean-François Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l'Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit), Université Laval, 1401, 18e rue, Local H-012a, G1J 1Z4, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Boutin Amélie Centre de Recherche FRQ-S du Centre Hospitalier Affilié Universitaire de Québec (Hôpital de l'Enfant-Jésus), Traumatologie—Urgence—Soins Intensifs (CHA-Research Center [Enfant-Jésus Hospital], Trauma—Emergency—Critical Care Medicine Unit), Université Laval, 1401, 18e rue, Local H-012a, G1J 1Z4, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Brochu Jacques Division of Critical Care Medicine, Department of Anesthesiology, Université Laval, Quebec, QC, Canada aut NATIONALLICENCE 700 1- Fergusson Dean Clinical Epidemiology Unit, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/1(2013-02-01), 154-160 1541-6933 18:1<154 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer