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Abstract
In critically ill patients, it is frequently challenging to identify who will benefit from admission to the intensive care unit and life-sustaining interventions when the chances of a meaningful outcome are unclear. In addition, the acute illness not only affects the patients but also family members or surrogates who often are overwhelmed and unable to make thoughtful decisions. In these circumstances, a time-limited trial (TLT) of intensive care treatment can be helpful. A TLT is an agreement to initiate all necessary treatments or treatments with clearly delineated limitations for a certain period of time to gain a more realistic understanding of the patient’s chances of a meaningful recovery or to ascertain the patient’s wishes and values. In this article, we discuss current research on different aspects of TLTs in the intensive care unit. We propose how and when to use TLTs, discuss how much time should be taken for a TLT, give an overview of the potential impact of TLTs on healthcare resources, describe ethical challenges concerning TLTs, and discuss how to evaluate a TLT.
Details
1 Department of Pulmonology and Critical Care, Langone Medical Center-Bellevue Hospital, New York University, New York, NY, USA; Department of Intensive Care Adults, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
2 Service de Reanimation Medicale, Hopital Saint-Louis et Universite Paris 7, Assistance Publique, Hospitaux de Paris, Paris, France
3 Division of Medical Ethics, School of Medicine, New York University, New York, NY, USA
4 Department of Intensive Care Adults, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
5 Department of Pulmonology and Critical Care, Langone Medical Center-Bellevue Hospital, New York University, New York, NY, USA; Department of Intensive Care Adults, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands; Division of Pulmonary, Allergy and Critical Care, University Medical Center, Columbia University College of Physicians and Surgeons, New York, NY, USA; Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile; Department of Pulmonary and Critical Care, New York University, New York, NY, USA