The low frequency of futility in an adult intensive care unit setting

It is widely assumed that "futile" treatment consumes significant health care resources. This is a prospective cohort study.

The setting was the medical intensive care unit of Ben Taub General Hospital, a large public hospital in Houston, Tex.

To assess the frequency of intensive care unit patients meeting any of three broad definitions of futility.

Subjects consisted of 129 consecutive patients admitted to the study intensive care unit during a 6-week period in the fall of 1993.

Operational definitions for three types of futility described in the literature were developed: Imminent demise futility, death imminent regardless of intervention, was assessed by using the APACHE II (Acute Physiology and Chronic Health Evaluation II) scoring system to determine the likelihood of mortality at more than the 90%, 95%, and 99% probabilities. Lethal condition futility, conditions incompatible with long-term survival, included five separate disease processes. Qualitative futility, conditions with an unacceptable quality of life, was assessed as a persistent vegetative state or as meeting criteria for poor prognosis due to a hypoxic ischemic coma.

Only 2 bed-days (0.3%) were used by patients with more than 90% predicted mortality; 22 bed-days (3.6%) were used by patients with poor prognosis due to hypoxic ischemic coma; and 101 bed-days (16.4%) were used by patients satisfying criteria for the five lethal conditions.

The frequency of futile interventions appears to be low unless one is willing to accept a definition that includes patients who could survive for many months. If confirmed in other settings, this suggests that concepts of futility will not play a major role in costs containment.