Reasons for Withdrawing and Withholding Life (WH/WD) Support to Patients in a General Intensive Care Unit.

Introduction:  Withholding (WH) of life support was defined as the decision not to start or increase a life-sustaining intervention and withdrawing (WD) of life support was defined as the decision to actively stop a life sustaining intervention This study aims to understand the reasons for withholding/withdrawal of life support and its frequency in the context of Nepal. Methods:  A descriptive cross sectional study of ICU patients with poor prognosis from January 2017 to December 2018 year was undertaken in KMCTH. Results: The total number of patients who underwent withdrawal of life support during the time period of study for various reasons was 53. Among them, 30 (56.6%) were males and 23 (43.4%) were females. The mean age of patients included in the study ranged from 17 to 89 years of age with an average age of 59.1 years. The calculated APACHE score ranged from 50 to 10 and the predicted mortality ranged from 98.4% to 6.9%. The mean of calculated APACHE score was 33.6% and mean of predicted mortality was 73%. Of the total 53 patients, 30 patients were taken off life support due to poor prognosis, 9 due to financial constraints and 14 due to both poor prognosis and financial constraints. Conclusion: The most common reasons for WH/WD of life support is either poor prognosis or financial constraints or both.