DECISIONS TO LIMIT OR TO MAXIMIZE THE THE RAPEUTIC SUPPORT IN A NEUROSURGICAL INTENSIVE-CARE UNIT

Objective: To assess the respective rates of intensive care maximaliza tion, limitation and withdrawal practice in a neurosurgical intensive care unit. Study design: Prospective clinical study. Patients: All pat ients who died in the unit during the year 1994 were included in this study. Methods: Demographic data and medical history of these patients were collected, and treatments during the last days and the 24 hours before death were reviewed. Results: Among the 49 cases collected duri ng the study period, 16 patients (33%) received full intensive therapy until their death. In 29 (59%), death was preceded by some limitation of treatment, and in 4 (8%) life-sustaining treatment (mechanical ven tilation, vasopressor infusion) had not been undertaken. Conclusion: T his prospective study confirmed the results of several previous survey s. The medical decision to limit or to discontinue treatments is rathe r frequent in intensive care units. This is an illegal practice in Fre nch legislation and code of professional ethics. Recommendations by re presentative French medical associations on the modalities of decision making on limitation of therapy would be welcome.