1 Frontera J.A.

Curtis J.R.

Nelson J.E.

et al. Integrating palliative care into the care of neurocritically ill patients: a report from the Improving Palliative Care in the ICU Project Advisory Board and the Center to Advance Palliative Care.

2 Becker K.J.

Baxter A.B.

Cohen W.A.

et al. Withdrawal of support in intracerebral hemorrhage may lead to self-fulfilling prophecies.

Advances in critical care medicine have led to an increase in patients who survive the initial phase of critical care. For these survivors, the impact of brain injuries on the probability of regaining consciousness, further cognitive disability, and, more generally speaking their overall quality of life is tremendous. Currently, most patients with acute brain injury that die early following injury expire in the context of limitation or withdrawal of life sustaining treatments (WLST).Decisions that shift the goals of care from full support to WLST are typically driven by discussions between caregivers and families about the likely patient's outcome. However, accurate prediction of recovery in a brain injured patient is extremely challenging, especially during the acute phase. Timing and willingness to pursue WLST vary greatly, but if built on prognostic uncertainty, carry a high risk of promoting a self-fulfilling prophecy bias.