SCCM Resource Library-Using Time-Limited Trials to Navigate Uncertainty and Hope in the ICU

Pdf Summary

The article from CriticalConnections, Summer 2024, discusses "Time-Limited Trials" (TLTs) in critical care. TLTs involve a collaborative, predefined period of life-sustaining treatment agreed upon by clinicians and the patient or surrogate decision-makers, intended to evaluate patient recovery or guide decisions toward comfort-focused care if recovery isn't feasible. This approach is valuable when patient prognosis is uncertain or goals of care are unclear.<br /><br />The article highlights the case of a 76-year-old woman with COPD and heart failure, facing possible mechanical ventilation due to acute respiratory failure. Her family's uncertainty concerning her preferences exemplifies TLT's potential utility, given their understanding of her wish to avoid prolonged invasive treatments based on past experiences.<br /><br />The benefits of TLTs include reducing diagnostic and prognostic uncertainty over time, helping patients and families process the critical illness's impact, and fostering clearer communication and decision-making. By using structured evaluation plans with defined end points, TLTs offer transparency and can mitigate conflicts, aligning all parties on clinical trajectories based on agreed improvements or deteriorations.<br /><br />However, several pitfalls can complicate TLTs, such as a lack of clarity around trial parameters and potential clinician interpretation variability. Recommendations to avoid these include transparent parameter setting based on best practices and regular, documented multidisciplinary discussions to ensure consistent messaging. Additionally, challenges include the psychological difficulty of withdrawing care and determining when TLTs are inappropriate due to low chances of treatment success.<br /><br />Ultimately, TLTs aim to align patient care with their values, minimize unnecessary treatments, and help navigate the complex emotions and decision-making processes at the end of life, while avoiding potential harms through careful planning and ethical considerations.

Asset Subtitle

Research, 2024, 0:09:57

Asset Caption

"This article was first published in the Summer 2024 issue of Critical Connections.

A time-limited trial (TLT) is a collaborative plan among clinicians and a patient and/or their surrogate decision-maker to use life-sustaining therapy for a defined duration. During a TLT, the patient’s response to therapy informs the decision as to whether to continue care directed toward recovery, transition to care focused exclusively on comfort, or extend the trial’s duration. In this article, the authors discuss the utility of TLTs when uncertainty exists about the patient’s prognosis or ambiguity around goals of care complicates medical decision-making.

Critical Connections, the critical care industry’s only newsmagazine, provides information on cutting-edge topics in critical care useful to the entire multiprofessional team."

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Content Type Article

Knowledge Area Research

Membership Level Associate

Membership Level Professional

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Tag Clinical Research Design

Year 2024

Keywords

Time-Limited Trials

critical care

patient recovery

life-sustaining treatment

patient prognosis

decision-making

mechanical ventilation

diagnostic uncertainty

multidisciplinary discussions

ethical considerations

Article

Research

Clinical Research Design

2024

Associate

Professional

Select

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