Time-limited trial – searching for rational solutions in the functioning of intensive care units

Introduction
Evaluating futility carries the burden of subjectivity; we do not have scales that verify the impartiality of decisions. It is very difficult to decide on the fate of a patient who shows up intubated at the Intensive Care Unit (ICU). The uncertainty of the prognosis at the beginning of a critical illness does not allow the doctor to predict the effect of therapy in terms of survival, regaining the previous quality of life, and independent functioning.

Material and methods
There are 3 options to choose from: ICU admission and all invasive procedures; refusal of ICU admission, with a sense of making decisions based on incomplete information; and a time-limited trial, which allows testing invasive procedures aimed at the potential improvement of the patient’s health and the reassessment of gains and losses after a specific, defined period. It seems that the last solution is fair and acceptable to the patient/family and medics.

Results
A time-limited trial is part of the concept of personalized medicine, which puts the patient at the centre of our actions. A time-limited trial is a practical proposition for patients with a doubtful prognosis and uncertainty concerning the effects of invasive and aggressive therapies.

Conclusions
Patients with a limited life expectancy and exhausted physiological reserves are ideal candidates for the implementation of the described method.