Respiratory support withdrawal in intensive care units international differences stressed and straightened! 英文参考文献.docVIP

Epker et al. Critical Care 2011,15:405 /content/15/2/405 LET TER Respiratory support withdrawal in intensive care units: international di? erences stressed and straightened! Jelle L Epker*, Yorick J de Groot and Erwin J Kompanje See related research by Fumis and Deheinzelin, /content/14/6/R235 We read with great interest the article by Fumis and Second, Fumis and Deheinzelin state that European Deheinzelin [1] in a previous issue of Critical Care. We ICU physicians are, in comparison with their North are convinced that the subject – the withdrawal of American colleagues, less inclined to withdraw treat- is statement is not in concordance with our own experienc e withdrawal rate in our Dutch ICU is 83% respiratory support in intensive care units (ICUs) – is of interest to the ICU community but think that some of the conclusions are somewhat disputable. ment. of the patients who died in the IC is result is fully First, we agree with the authors that family involvement in the withdrawal process is important; however, this does not necessarily imply that relatives should join in the supported by the ETHICUS (Ethics in European Intensive Care Units) study, which reported that with- drawal of treatment is a generally accepted form of end- of-life care in Europe, especially in Northern Europe [4]. Finally, in our opinion, it is the treating physician who, withdrawal decision-making is point was already demonstrated by Azoulay and colleagues [2], who showed that direct participation in the withdrawal deci sion of after consultation with colleagues, has the knowledge and experience to make a clear and fair judgment family members is directly associated with feelings of guilt and the development of post-traumatic stress reactions concerning the prognosis of a patient. In case of a poor (PTSRs). prog