Consider a 75-year-old patient hospitalised to the intensive care unit (ICU) for severe hypoxemic respiratory failure owing to pneumonia and systolic heart failure. Despite the fact that she has a possibly curable infection, her senior age and chronic disease enhance her chances of a poor result. Given what they know about her values and interests, her family is torn on whether mechanical ventilation would be appropriate. Clinicians, patients, and surrogate decision-makers in the ICU commonly encounter problems of prognostic ambiguity and confusion about patients’ objectives and values. TLTs of life-sustaining therapies in the ICU have been proposed as one method to aid in goal-concordant care in the middle of a complicated and high-stakes decision-making environment. TLTs are an agreement between doctors and patients or surrogate decision-makers to utilise a therapy for a certain length of time, with a plan for subsequent review of the patient’s status based on previously defined criteria for improvement or deterioration. In this paper, we will go through the notion of TLTs in critical care and look at their possible benefits, obstacles, and problems.
TLTs are done infrequently and usually inadequately in practise, according to research, and are hampered by system-level issues that reduce their efficacy. The promise of TLTs in intensive care warrants continued research efforts, including implementation studies to improve adoption and fidelity, observational research to determine optimal time frames for TLTs, and interventional trials to determine whether TLTs ultimately improve the delivery of goal-concordant care in the ICU.
