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Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study
Jean-Christophe Orban1, Yannick Walrave, Nicolas Mongardon
1From the Réanimation Polyvalente et Surveillance Continue, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France (J.-C.O., Y.W., C.I.); Service d'Anesthésie et des Réanimations Chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France (N.M., G.D.); Département d'Anesthésie-Réanimation, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France (B.A.); Réanimation Médicale, Hôpital Edouard-Herriot, Hospices Civils de Lyon, Lyon, France (L.A.); Réanimation Chirurgicale, Hôpital de la Croix-Rousse, Hospices Civils de Lyon, Lyon, France (F.A.); Réanimation, Centre Hospitalier Interrégional de Compiègne Noyon, Compiègne, France (G.B.); Réanimation Adultes et Unité de Soins Intensifs, Centre Hospitalier Universitaire de Clermont-Ferrand, Clermont-Ferrand, France (J.-M.C.); Réanimation Polyvalente, Hôpital Sainte-Musse, Centre Hospitalier Interrégional de Toulon-La Seyne sur mer, Toulon, France (J.D.-G., C.G.); Réanimations, Centre Hospitalier Universitaire de Amiens Picardie-Site Sud, Amiens, France (H.D.); Anesthésie et Réanimation Adulte, Hôpital Purpan, Centre Hospitalier Universitaire de Toulouse, Toulouse, France (M.G.); Service de Réanimation, Hôpital Inter-Armées Sainte-Anne, Toulon, France (P.G.); Réanimation Médicale, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris, Paris, France (B.G.); Réanimation Médicale, Hôpital l'Archet 2, Centre Hospitalier Universitaire de Nice, Nice, France (H.H.); Département d'Anesthésie et de Réanimation B, Centre Hospitalier Universitaire de Montpellier, Montpellier, France (S.J.); Division Anesthésie Réanimation Douleur Urgences, Centre Hospitalier Universitaire de Nîmes, Nîmes, France (J.-Y.L.); Réanimation Chirurgicale, Centre Hospitalier Universitaire de Rennes, Rennes, France (Y.M.); Réanimation Polyvalente B, Hôpital Nord, Centre Hospitalier Universitaire de Saint-Etienne, Saint-Priest En Jarez, France (J.M.); Service d'Anesthésie-Réanimation II, Centre Hospitalier Universitaire de Bordeaux, Bordeaux, France (A.O.); Service de Réanimation Polyvalente, Centre Hospitalier Universitaire Dupuytren, Limoges, France (N.P.); Réanimation Polyvalente, Centre Hospitalier de Beauvais, Beauvais, France (A.-M.G.R.); Réanimation et Surveillance Continue, Centre Hospitalier de Annecy Genevois, Epagny Metz-Tessy, France (M.S.); Service de Réanimation Polyvalente, Centre Hospitalier Princesse Grace, Monaco City, Monaco (A.T.); and Service d'Anesthésie Réanimation, Hôpital de la Conception (S.W.) and Service Anesthésie et Réanimation, Hôpital Nord (L.Z., M.L.), Assistance Publique-Hôpitaux de Marseille, Marseille, France.
Background:
Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.
Methods:
An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest).
Results:
A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths.
Conclusions:
In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.
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