Evidence map›Paper›PMID 25904183›Full record

SynthesisIntensive care medicine2015

Global variability in withholding and withdrawal of life-sustaining treatment in the intensive care unit: a systematic review.

N M Mark, S G Rayner, N J Lee, J R Curtis

2 registry-linked trialsAbstract readComparative StudySystematic Review
PubMed Publisher
In one paragraph

Synthesis in Intensive care medicine, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to 2 registered trials, which are not on this map. Cited by 127 papers, 10 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
127citing papers in PubMed, 10 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT04131140 completednot on this map

Differences Across ICUs in Organ Donation After Brain Death: A Nationwide Study of Relationship With Variation in End-of-life Decisions

Typeobservational_patient_registrySponsorSwedish Intensive Care RegistryRan2014 to 2018Enrolled12,072ConditionsDecision Making, Terminal Illness, Tissue and Organ Procurement
NCT07069010 recruitingnot on this mapstarted 2025, after this paper: background citation

Evaluation of Burnout Syndrome Among Healthcare Professionals in Intensive Care Units Within the EPIC (Enhancing Palliative Care in ICU) Research

TypeobservationalSponsorUniversity of AthensRan2025 to 2027Enrolled100ConditionsBurnout Syndrome
3 · Its place in the literature

Who cites it

127 citing papers in PubMed, 10 syntheses or guidelines pooled it.

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  10. Prone position for acute respiratory failure in adults.The Cochrane database of systematic reviews · 2015
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67 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

4 authors.

N M MarkHarborview Medical Center, University of Washington, Seattle, WA, USA, nickmark@uw.edu.
S G Rayner
N J Lee
J R Curtis

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePrior studies identified high variability in prevalence of withdrawal of life-sustaining treatment in the ICU. Variability in end-of-life decision-making has been reported at many levels: between countries, ICUs, and individual intensivists. We performed a systematic review examining regional, national, inter-hospital, and inter-physician variability in withdrawal of life-sustaining treatment in the ICU.

methodsUsing a predefined search strategy, we queried three electronic databases for peer-reviewed articles addressing withdrawal of life-sustaining treatment in adult patients in the ICU. Data were analyzed for variability in prevalence of withdrawal of life-sustaining treatment. Withholding of life-sustaining treatment was also examined where information was provided. An assessment tool was developed to quantify the risk of bias in the included articles.

resultsWe identified 1284 studies, with 56 included after review. Most studies had unclear or high risk of bias, primarily due to unclear case definitions or potential confounding. The mean prevalence of withdrawal of life-sustaining treatment for patients who died varied from 0 to 84.1% between studies, with standard deviation of 23.7%. Sensitivity analysis of general ICU patients yielded similar results. Withholding also varied between 5.3 and 67.3% (mean 27.3, SD 18.5%). Substantial variability was found between world regions, countries, individual ICUs within a country, and individual intensivists within one ICU.

conclusionsWe identified substantial variability in the withdrawal of life-sustaining treatment across world regions and countries. Similar variability existed between ICUs within countries and even between providers within the same ICU. Further study is necessary, and could lead to interventions to improve end-of-life care in the ICU.

Indexed as

Intensive Care UnitsLife Support CareWithholding TreatmentAdultHumansInternationality

Identifiers

PMID25904183

What OpenQuestion holds

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Read underepoch 390

Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.