Time-limited trials for patients with critical illness: a review of the literature

Chest. 2023 Dec 13:S0012-3692(23)05855-5. doi: 10.1016/j.chest.2023.12.014. Online ahead of print.ABSTRACTTOPIC IMPORTANCE: Since the 1990s, "time-limited trials" have been described as an approach to navigate uncertain benefits and limits of life-sustaining therapies in patients with critical illness. In this review, we aim to synthesize the evidence on time-limited trials in critical care, establish what is known, and highlight important knowledge gaps.REVIEW FINDINGS: We identified 18 empirical studies and 15 ethical analyses about time-limited trials in patients with critical illness. Observational studies suggest time-limited trials are part of current practice in intensive care units (ICU) in the United States, but their use varies according to unit and clinician factors. Some ICU clinicians are familiar with, endorse, and have participated in time-limited trials, and some older adults appear to favor time-limited trial strategies over indefinite life-sustaining therapy or care immediately focused on comfort. When time-limited trials are used, they are often implemented incompletely and challenged by systematic barriers such as continually rotating ICU staff. Predictive modeling studies support prevailing clinical wisdom that prognostic uncertainty decreases over time in the ICU for some patients. One study prospectively comparing usual ICU care with an intervention designed to support time-limited trials yielded promising preliminary results. Ethical analyses describe ...
Source: Chest - Category: Respiratory Medicine Authors: Source Type: research