Guidelines for Decisions to Withhold or Withdraw Life-Sustaining Treatments (LST) in Adult ICU
Abstract
OBJECTIVE: The French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Physical Medicine and Rehabilitation (Société Française de Médecine Physique et de Réadaptation (SOFMER)) aimed at providing guidelines for decisions to withhold or withdraw life-sustaining treatments (LST) in adult ICU. DESIGN: A consensus committee of 20 experts from the SFAR and the SOFMER was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: 3 fields were defined: (1) modalities of the LST decision-making process; (2) modalities for implementing an LST decision; (3) Relationships with family members, communication, disagreements, and conflicts. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE® grid method. RESULTS: The experts' work on synthesis and application of the GRADE® method resulted in 9 recommendations. Among the formalized recommendations, 1 was found to have a high level of evidence (GRADE 1), and 2 had low levels of evidence (GRADE 2). For 6 recommendations, the GRADE® methodology could not be fully applied, resulting in an expert's opinion. 2 questions could not be answered due to a lack of literature. After 1 round of rating, strong agreement was reached for all the recommendations. CONCLUSIONS: There was strong agreement among experts to provide recommendations to improve practices for decisions to withhold or withdraw LST in the adult ICU.
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BibTeX
@article{giabicani2026guidelines,
title = {{Guidelines for Decisions to Withhold or Withdraw Life-Sustaining Treatments (LST) in Adult ICU}},
author = {Mikhael Giabicani and Gérard Audibert and Enora Atchade and Flora Bastiani and Elodie Brunel and Marie Citrini and Claire Dahyot-Fizelier and Nicolas Engrand and Clément Gakuba and Agathe Kudela and Yoann Launey and Yann Le Guen and Jonathan Lévy and Olivier Maillé and Jerome Morel and Pierre-François Perrigault and Sylvaine Robin and Christelle Rosenstrauch and Léa Satre-Buisson and Pierre Trouiller and Denis Frasca and Elise Langouet},
journal = {Anaesthesia Critical Care \& Pain Medicine},
year = {2026},
month = nov,
doi = {10.1016/j.accpm.2026.101892},
url = {https://hal.science/hal-05847698v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Guidelines for Decisions to Withhold or Withdraw Life-Sustaining Treatments (LST) in Adult ICU
AU - Mikhael Giabicani
AU - Gérard Audibert
AU - Enora Atchade
AU - Flora Bastiani
AU - Elodie Brunel
AU - Marie Citrini
AU - Claire Dahyot-Fizelier
AU - Nicolas Engrand
AU - Clément Gakuba
AU - Agathe Kudela
AU - Yoann Launey
AU - Yann Le Guen
AU - Jonathan Lévy
AU - Olivier Maillé
AU - Jerome Morel
AU - Pierre-François Perrigault
AU - Sylvaine Robin
AU - Christelle Rosenstrauch
AU - Léa Satre-Buisson
AU - Pierre Trouiller
AU - Denis Frasca
AU - Elise Langouet
PY - 2026
DA - 2026/11/02
JO - Anaesthesia Critical Care & Pain Medicine
DO - 10.1016/j.accpm.2026.101892
UR - https://hal.science/hal-05847698v1
AB - OBJECTIVE: The French Society of Anaesthesia and Intensive Care Medicine (Société française d'anesthésie et de réanimation, SFAR) and the French Society of Physical Medicine and Rehabilitation (Société Française de Médecine Physique et de Réadaptation (SOFMER)) aimed at providing guidelines for decisions to withhold or withdraw life-sustaining treatments (LST) in adult ICU. DESIGN: A consensus committee of 20 experts from the SFAR and the SOFMER was convened. A formal conflict-of-interest (COI) policy was developed at the beginning of the process and enforced throughout. The entire guideline construction process was conducted independently of any industrial funding (i.e., pharmaceutical, medical devices). The authors were required to follow the rules of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide the assessment of the quality of evidence. The potential drawbacks of making strong recommendations in the presence of low-quality evidence were emphasized. METHODS: 3 fields were defined: (1) modalities of the LST decision-making process; (2) modalities for implementing an LST decision; (3) Relationships with family members, communication, disagreements, and conflicts. For each field, the objective of the recommendations was to answer a number of questions formulated according to the PICO model (population, intervention, comparison, and outcomes). Based on these questions, an extensive bibliographic search was carried out using predefined keywords according to PRISMA guidelines and analyzed using the GRADE® methodology. The recommendations were formulated according to the GRADE® methodology and then voted on by all the experts according to the GRADE® grid method. RESULTS: The experts' work on synthesis and application of the GRADE® method resulted in 9 recommendations. Among the formalized recommendations, 1 was found to have a high level of evidence (GRADE 1), and 2 had low levels of evidence (GRADE 2). For 6 recommendations, the GRADE® methodology could not be fully applied, resulting in an expert's opinion. 2 questions could not be answered due to a lack of literature. After 1 round of rating, strong agreement was reached for all the recommendations. CONCLUSIONS: There was strong agreement among experts to provide recommendations to improve practices for decisions to withhold or withdraw LST in the adult ICU.
SN - 2352-5568
ER -