Changes in Orders for Life-Sustaining Treatment in Patients Requiring Prolonged Mechanical Ventilation

Growing numbers of acute critical illness survivors experience chronic critical illness (CCI) marked by prolonged dependence on life support, delirium, and/or disability. There is minimal recent data on treatment limitations in CCI. To evaluate the natural history of changes in orders for life-sustaining treatment (OLST) in patients requiring prolonged mechanical ventilation. Retrospective cohort study of 410 patients who received tracheostomy in an intensive care unit for prolonged respiratory failure. Three hundred twenty-four patients had one OLST throughout the admission, with no limitations on prearrest life-sustaining treatment or cardiopulmonary resuscitation. The 86 patients who underwent at least one change in OLST were older, had longer admissions, were more likely to be deceased at hospital discharge, and were more likely to have received specialty palliative care. Thirty percent of OLST changes occurred in the last week of admission. OLST occur infrequently and late in patients with CCI.