Therapiebegrenzung in der Intensivmedizin - Was ist in der Praxis zu beachten?

Abstract

End-of-life decisions (EOLD) are frequently used in patients who die in the intensive care unit. The decision to limit life support and the extent of limitation depends on the nature of the disease, its progress and the presumed prognosis and, equally important, the patient's preferences. These preferences should be stated by the patient if he or she is able to do so. If not, the patient's assumed will can be elicited by using written advance directives or with the help of surrogate decision makers.Primarily withholding life-sustaining treatment is reasonable in patients who present with an endstage, irreversibly progressive disease or if the patient explicitly rejects intensive care treatment.Limiting the extent of intensive care medicine by withholding specific procedures (e.g. resuscitation) should be discussed in critically ill patients whose prognosis would become futile with an additional serious medical problem.Withdrawing life-sustaining treatment and changing to palliative care should be considered if intensive care medicine is futile because of the severity of the patient's condition.It is vital to find an interdisciplinary consensus about EOLD within the medical team as well as with the patient/surrogate decision maker. The agreement is documented in the patient's chart.