Evaluating Physician Variability in Use of Time-Limited Trials in Mechanically Ventilated Patients

Tuesday, March 24, 2026

11:15 AM - 12:15 PM Central Time

Location: Connections Central - RST 01

Andrew Wu, MD (he/him/his)

Disclosure(s): No relevant financial relationship(s) to disclose.
CO

Cemre Orhan, PhD

Researcher
University of Wisconsin

Disclosure information not submitted.
JM

Joy Moy, MD, MPH, MS

Scientist
Division of Allergy, Pulmonary, and Critical Care; Department of Medicine, University of Wisconsin School of Medicine and Public Health

Disclosure information not submitted.
EC

Emily Campbell, BA

Clinical Research Coordinator
Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
FM

Francisco Martinez, BS

Research Coordinator
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
HD

Helen Donnelly, MS, BSN, RN, CCRC

Clinical Research Nurse/Clinical Research Associate
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
EK

Erin Korth, BA

Research Project Coordinator
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
MP

Madison Polley, BA

Clinical Research Coordinator II
Division of Allergy, Pulmonary, and Critical Care; Department of Medicine, University of Wisconsin School of Medicine and Public Health

Disclosure information not submitted.
BH

Bret Hanlon, PhD

Scientist III
Department of Biostatistics and Medical Informatics; University of Wisconsin

Disclosure information not submitted.
LS

Lily N. Stalter, MS

Biostatistician II
University of Wisconsin Department of Surgery

Disclosure information not submitted.
NN

Nandita R. Nadig, MD, MSCR

Associate Professor
Division of Pulmonary and Critical Care, Department of Medicine, Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
KS

Katharine Secunda, MD (she/her/hers)

University of Pennsylvania

Disclosure(s): No relevant financial relationship(s) to disclose.
LP

Lesley Pinzon, MPH

Research Coordinator
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
TR

Timothy Rowe, MD

Assistant Professor
Division of Pulmonary and Critical Care; Department of Medicine; Northwestern University Feinberg School of Medicine

Disclosure information not submitted.
AA

Arsalan Ahmad, MS (he/him/his)

Wisconsin

Disclosure(s): No relevant financial relationship(s) to disclose.
DW

Douglas A. Wiegmann, PhD

Professor
Department of Industrial and Systems Engineering, University of Wisconsin, Wisconsin

Disclosure information not submitted.
EV

Elizabeth M. Viglianti, MD MPH MSc

Assistant Professor
Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan

Disclosure information not submitted.
SH

Scott D. Halpern, MD, PhD, MBE

Professor
Division of Pulmonary, Allergy, and Critical Care; Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
JC

Justin Clapp, PhD, MPH

Assistant Professor
Palliative and Advanced Illness Research (PAIR) Center, Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
JK

Jacqueline Kruser, MD, MS

Assistant Professor
University of Wisconsin School of Medicine and Public Health

Disclosure information not submitted.

Introduction: A time-limited trial (TLT) is a collaborative plan among patients, surrogates, and clinicians to try life-sustaining therapy for a defined duration for critically ill patients whose prognosis is uncertain. Prior work demonstrates variability in physicians’ use of TLTs, but little is known about the drivers of this variability. We sought to test the hypothesis that physician characteristics are associated with TLT use.

Methods: This is a secondary analysis of an observational study in medical ICUs within 5 hospitals, focused on identifying TLTs in patients with respiratory failure receiving mechanical ventilation. Attending ICU physicians for all ventilated patients received 1) a query asking whether a TLT was being used with 3 options (yes, considering, or no) and 2) a voluntary demographic survey. We performed t-tests and Chi squared tests to evaluate the relationships between physician characteristics and TLT use.

Results: Of 117 unique physicians, 27 (23.1%) never conducted or considered a TLT (non-adopters), 69 (59.0%) conducted at least 1 TLT, and 21 (17.9%) considered at least 1 TLT but never used a TLT. Excluding non-adopters, mean frequency of physician TLT use was 11.9% (SD 17.0%) of ventilated patients. Among 79 responders to the demographic survey (67.5% response rate), the proportion of non-adopters was 10 / 44 (22.7%) in physicians with 10 years or less in practice, 4 / 23 (17.4%) in those with 11 to 20 years, and 4 / 12 (33.3%) in those with > 20 years (p = 0.58). Among 29 female physicians, 6 (20.7%) were non-adopters compared to 12 (24.5%) of 49 male physicians (p = 0.70). When stratified by patient volume (# of ventilated patients cared for during study period), 43.3% of physicians in the lowest-volume quartile were non-adopters compared to 3.5% in the highest-volume quartile (p < 0.001).

Conclusions: We found that ICU physicians with higher patient volume during our study were more likely to use or consider TLTs, but we did not find a relationship between physicians’ years in practice or gender. This finding could represent ascertainment bias or reflect that physicians who spend more time in the ICU are more likely to utilize TLTs. Future research should seek to uncover and characterize physicians’ reasoning about why and whether they use TLTs.