Article (Scientific journals)
Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study.
van Veen, Ernest; van der Jagt, Mathieu; Citerio, Giuseppe et al.
2021In Intensive Care Medicine, 47 (10), p. 1115-1129
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Keywords :
Brain Injuries, Traumatic; Cohort Studies; Glasgow Coma Scale; Humans; Intensive Care Units; Prospective Studies; Critical care; Intensive care unit; Traumatic brain injury; WLSM
Abstract :
[en] BACKGROUND: In patients with severe brain injury, withdrawal of life-sustaining measures (WLSM) is common in intensive care units (ICU). WLSM constitutes a dilemma: instituting WLSM too early could result in death despite the possibility of an acceptable functional outcome, whereas delaying WLSM could unnecessarily burden patients, families, clinicians, and hospital resources. We aimed to describe the occurrence and timing of WLSM, and factors associated with timing of WLSM in European ICUs in patients with traumatic brain injury (TBI). METHODS: The CENTER-TBI Study is a prospective multi-center cohort study. For the current study, patients with traumatic brain injury (TBI) admitted to the ICU and aged 16 or older were included. Occurrence and timing of WLSM were documented. For the analyses, we dichotomized timing of WLSM in early (< 72 h after injury) versus later (≥ 72 h after injury) based on recent guideline recommendations. We assessed factors associated with initiating WLSM early versus later, including geographic region, center, patient, injury, and treatment characteristics with univariable and multivariable (mixed effects) logistic regression. RESULTS: A total of 2022 patients aged 16 or older were admitted to the ICU. ICU mortality was 13% (n = 267). Of these, 229 (86%) patients died after WLSM, and were included in the analyses. The occurrence of WLSM varied between regions ranging from 0% in Eastern Europe to 96% in Northern Europe. In 51% of the patients, WLSM was early. Patients in the early WLSM group had a lower maximum therapy intensity level (TIL) score than patients in the later WLSM group (median of 5 versus 10) The strongest independent variables associated with early WLSM were one unreactive pupil (odds ratio (OR) 4.0, 95% confidence interval (CI) 1.3-12.4) or two unreactive pupils (OR 5.8, CI 2.6-13.1) compared to two reactive pupils, and an Injury Severity Score (ISS) if over 41 (OR per point above 41 = 1.1, CI 1.0-1.1). Timing of WLSM was not significantly associated with region or center. CONCLUSION: WLSM occurs early in half of the patients, mostly in patients with severe TBI affecting brainstem reflexes who were severely injured. We found no regional or center influences in timing of WLSM. Whether WLSM is always appropriate or may contribute to a self-fulfilling prophecy requires further research and argues for reluctance to institute WLSM early in case of any doubt on prognosis.
Disciplines :
Human health sciences: Multidisciplinary, general & others
Author, co-author :
van Veen, Ernest ;  Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000  ; Department of Intensive Care Adults, Erasmus MC - University Medical Center
van der Jagt, Mathieu;  Department of Intensive Care Adults, Erasmus MC - University Medical Center,
Citerio, Giuseppe;  School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy. ; San Gerardo Hospital, ASST-Monza, Monza, Italy.
Stocchetti, Nino;  Department of Physiopathology and Transplantation, Milan University, Milan, Italy. ; Neuro ICU Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico Milano, Milan,
Gommers, Diederik;  Department of Intensive Care Adults, Erasmus MC - University Medical Center,
Burdorf, Alex;  Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000
Menon, David K;  Department of Anaesthesia, University of Cambridge, Cambridge, UK.
Maas, Andrew I R;  Department of Neurosurgery, Antwerp University Hospital and University of Antwerp,
Kompanje, Erwin J O;  Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000  ; Department of Medical Ethics and History of Medicine, Erasmus University Medical
Lingsma, Hester F;  Department of Public Health, Erasmus University Medical Center, P.O. Box 2040, 3000
CENTER-TBI investigators and, participants
Other collaborator :
Åkerlund, Cecilia
Amrein, Krisztina
Andelic, Nada
Andreassen, Lasse
Anke, Audny
Antoni, Anna
Audibert, Gérard
Azouvi, Philippe
Azzolini, Maria Luisa
Bartels, Ronald
Barzó, Pál
Beauvais, Romuald
Beer, Ronny
Bellander, Bo-Michael
Belli, Antonio
Benali, Habib
Berardino, Maurizio
Beretta, Luigi
Blaabjerg, Morten
Bragge, Peter
Brazinova, Alexandra
Brinck, Vibeke
Brooker, Joanne
Brorsson, Camilla
Buki, Andras
Bullinger, Monika
Cabeleira, Manuel
Caccioppola, Alessio
Calappi, Emiliana
Calvi, Maria Rosa
Cameron, Peter
Lozano, Guillermo Carbayo
Carbonara, Marco
Cavallo, Simona
Chevallard, Giorgio
Chieregato, Arturo
Citerio, Giuseppe
Clusmann, Hans
Coburn, Mark
Coles, Jonathan
Cooper, Jamie D
Correia, Marta
Čović, Amra
Curry, Nicola
Czeiter, Endre
Czosnyka, Marek
Fizelier, Claire Dahyot
Dark, Paul
Dawes, Helen
De Keyser, Véronique ;  Université de Liège - ULiège > Département de Psychologie
Degos, Vincent
Corte, Francesco Della
den Boogert, Hugo
Depreitere, Bart
Đilvesi, Đula
Dixit, Abhishek
Donoghue, Emma
Dreier, Jens
Dulière, Guy Loup
Ercole, Ari
Esser, Patrick
Ezer, Erzsébet
Fabricius, Martin
Feigin, Valery L
Foks, Kelly
Frisvold, Shirin
Furmanov, Alex
Gagliardo, Pablo
Galanaud, Damien
Gantner, Dashiell
Gao, Guoyi
George, Pradeep
GHUYSEN, Alexandre ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des urgences
Giga, Lelde
Glocker, Ben
Golubovic, Jagoš
Gomez, Pedro A
Gratz, Johannes
Gravesteijn, Benjamin
Grossi, Francesca
Gruen, Russell L
Gupta, Deepak
Haagsma, Juanita A
Haitsma, Iain
Helbok, Raimund
Helseth, Eirik
Horton, Lindsay
Huijben, Jilske
Hutchinson, Peter J
Jacobs, Bram
Jankowski, Stefan
Jarrett, Mike
Jiang, Ji Yao
Johnson, Faye
Jones, Kelly
Karan, Mladen
Kolias, Angelos G
Kompanje, Erwin
Kondziella, Daniel
Kornaropoulos, Evgenios
Koskinen, Lars Owe
Kovács, Noémi
Kowark, Ana
Lagares, Alfonso
Lanyon, Linda
LAUREYS, Steven  ;  Centre Hospitalier Universitaire de Liège - CHU > > Centre du Cerveau²
Lecky, Fiona
LEDOUX, Didier  ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Lefering, Rolf
Legrand, Valerie
Lejeune, Aurelie
Levi, Leon
Lightfoot, Roger
Lingsma, Hester
Maas, Andrew I R
Castaño, Ana M León
Maegele, Marc
Majdan, Marek
Manara, Alex
Manley, Geoffrey
Martino, Costanza
Maréchal, Hugues
Mattern, Julia
McMahon, Catherine
Melegh, Béla
Menon, David
Menovsky, Tomas
Mikolic, Ana
Misset, Benoît ;  Centre Hospitalier Universitaire de Liège - CHU > > Service des soins intensifs
Muraleedharan, Visakh
Murray, Lynnette
Negru, Ancuta
Nelson, David
Newcombe, Virginia
Nieboer, Daan
Nyirádi, József
Olubukola, Otesile
Oresic, Matej
Ortolano, Fabrizio
Palotie, Aarno
Parizel, Paul M
Payen, Jean François
Perera, Natascha
Perlbarg, Vincent
Persona, Paolo
Peul, Wilco
Piippo-Karjalainen, Anna
Pirinen, Matti
Pisica, Dana
Ples, Horia
Polinder, Suzanne
Pomposo, Inigo
Posti, Jussi P
Puybasset, Louis
Radoi, Andreea
Ragauskas, Arminas
Raj, Rahul
Rambadagalla, Malinka
Helmrich, Isabel Retel
Rhodes, Jonathan
Richardson, Sylvia
Richter, Sophie
Ripatti, Samuli
Rocka, Saulius
Roe, Cecilie
Roise, Olav
Rosand, Jonathan
Rosenfeld, Jeffrey V
Rosenlund, Christina
Rosenthal, Guy
Rossaint, Rolf
Rossi, Sandra
Rueckert, Daniel
Rusnák, Martin
Sahuquillo, Juan
Sakowitz, Oliver
Porras, Renan Sanchez
Sandor, Janos
Schäfer, Nadine
Schmidt, Silke
Schoechl, Herbert
Schoonman, Guus
Schou, Rico Frederik
Schwendenwein, Elisabeth
Sewalt, Charlie
Skandsen, Toril
Smielewski, Peter
Sorinola, Abayomi
Stamatakis, Emmanuel
Stanworth, Simon
Stevens, Robert
Stewart, William
Steyerberg, Ewout W
Stocchetti, Nino
Sundström, Nina
Takala, Riikka
Tamás, Viktória
Tamosuitis, Tomas
Taylo, Mark Steven
Ao, Braden Te
Tenovuo, Olli
Theadom, Alice
Thomas, Matt
Tibboel, Dick
Timmers, Marjolein
Tolias, Christos
Trapani, Tony
Tudora, Cristina Maria
Unterberg, Andreas
Vajkoczy, Peter
Vallance, Shirley
Valeinis, Egils
Vámos, Zoltán
van der Jagt, Mathieu
Van der Steen, Gregory
van der Naalt, Joukje
van Dijck, Jeroen T J M
van Essen, Thomas A
Van Hecke, Wim
van Heugten, Caroline
Van Praag, Dominique
van Veen, Ernest
Vyvere, Thijs Vande
van Wijk, Roel P J
Vargiolu, Alessia
Vega, Emmanuel
Velt, Kimberley
Verheyden, Jan
Vespa, Paul M
Vik, Anne
Vilcinis, Rimantas
Volovici, Victor
von Steinbüchel, Nicole
Voormolen, Daphne
Vulekovic, Petar
Wang, Kevin K W
Wiegers, Eveline
Williams, Guy
Wilson, Lindsay
Winzeck, Stefan
Wolf, Stefan
Yang, Zhihui
Ylén, Peter
Younsi, Alexander
Zeiler, Frederick A
Zelinkova, Veronika
Ziverte, Agate
Zoerle, Tommaso
More authors (238 more) Less
Language :
English
Title :
Occurrence and timing of withdrawal of life-sustaining measures in traumatic brain injury patients: a CENTER-TBI study.
Publication date :
October 2021
Journal title :
Intensive Care Medicine
ISSN :
0342-4642
eISSN :
1432-1238
Publisher :
Springer, Heidelberg, United States - Delaware
Volume :
47
Issue :
10
Pages :
1115-1129
Peer reviewed :
Peer Reviewed verified by ORBi
Funding number :
602150/Seventh Framework Programme/
Commentary :
© 2021. The Author(s).
Available on ORBi :
since 27 March 2022

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