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Published on: January 16, 2019
Analysis of terminal events in 109 successive deaths in a Belgian intensive care unit
Kalina Gajewska1, Michele Schroeder, Francoise De Marre
1Department of Intensive Care, Erasme University Hospital, Route de Lennik 808, 1070 Brussels, Belgium.
Insights
End-of-life decisions, including withdrawing or withholding therapy, are common in intensive care units (ICUs). ICU staff generally felt these decisions were timely and were satisfied with the outcomes.
Area of Science:
- Critical Care Medicine
- Medical Ethics
- Palliative Care
Background:
- End-of-life care decisions are a critical component of intensive care unit (ICU) management.
- Understanding the frequency and staff perceptions of these decisions is essential for improving patient care.
Purpose of the Study:
- To determine the incidence of end-of-life decisions in intensive care unit (ICU) patients.
- To assess the satisfaction of ICU team members with these end-of-life decisions.
Main Methods:
- Prospective data collection and questionnaires were utilized in a university hospital's 31-bed medicosurgical ICU.
- The study included 109 patients who died over a 3-month period, with questionnaires completed by ICU team members regarding end-of-life decisions.
Main Results:
- Therapeutic limitations, including withdrawing (n=43) and withholding (n=7) therapy, were frequent among dying ICU patients.
- Of the respondents, 82% felt end-of-life decisions were timely, while 15% felt they were too late.
Conclusions:
- Therapeutic limitations are common in ICU patients nearing end-of-life, with withdrawal of support being more frequent than withholding it.
- ICU staff generally expressed satisfaction with the end-of-life decisions made during the study period.
Objective:
To determine the incidence of end-of-life decisions in intensive care unit (ICU) patients.
Design And Setting:
Prospective data collection and questionnaire in a 31-bed medicosurgical ICU in a university hospital.
Patients And Participants:
All 109 ICU patients who died during a 3-month period (April-June 2001). Members of the ICU team were also invited to complete a questionnaire regarding the circumstances of each patient's death. Cardiopulmonary resuscitation was performed in 21 of the patients; other mechanisms leading to death were brain death (n=19), refractory shock (n=17), and refractory hypoxemia (n=2). The decision was taken in the remaining 50 patients to withdraw (n=43) or withhold (n=7) therapy. Questionnaires were completed for 68 patients, by physician and nurse in 40 cases, physician only in 20 cases, and nurse only in 8 cases. Questionnaires were obtained for 34 of 50 patients for whom a decision was made to limit therapy.
Results:
Respondents generally felt that the decision was timely (n=28, 82%), 5 (15%) felt the decision was too late, and one (3%) that the decision was made too soon, before the family could be informed.
Conclusions:
Therapeutic limitations are frequent in patients dying in the ICU, with withdrawing more common than withholding life support. Generally members of the ICU staff were satisfied with the end-of-life decisions made.
