Causes and Characteristics of Death in Intensive Care Units

Abstract

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.

COPD is independently associated with 6‐month survival in patients who have life support withheld in intensive care

“…In our study, 45% of patients for whom life support was withheld in the ICU were discharged. In accordance with the findings of previous studies, we found that half of the deaths in the ICU occurred after the decisions to withhold or withdraw life support . Among those patients for whom life support was withheld, 58.8% were still alive 6 months post‐discharge.…”

“…For instance, Ferrand et al reported in 2001 that, in 113 French ICUs, 53% of ICU deaths were preceded by a decision to withhold or withdraw life support and that such decisions affected approximately 10% of all patients. These findings have been confirmed in more recent studies and it appears that the withholding of life support in critically‐ill patients does not necessarily lead to death in the ICU. Ferrand et al reported an ICU discharge rate of 43% after Wh, and a recent study reported an ICU discharge rate of 37% and a hospital discharge rate of 17%.…”

Thromboprophylaxis, Delta SOFA and Main Outcomes in Ventilated Patients: An Analysis of the MIMIC-III Clinical Database

“…The analysis was adjusted for confounders age, gender, malignancy, smoking, chronic alcoholism, SOFA score at admission, night shift admissions, night shift deaths, weekend admission and weekend deaths (Table 4) [12]. Except Aspirin, all thromboprophylactic agents showed statistically signi cant reduction on ICU mortality (Table 4) (Table 4).…”

“…(a) SOFA scores at admission plotted against hospital mortality. The dotted lines represent high SOFA scores (12)(13)(14)(15)(16)(17), and the lines below (in order, 0 lowest, 11 highest) for lower SOFA scores at ICU admission. (b)Survival plot for SOFA scores at ICU admission.…”

End of life practice and perceptions among physicians and residents in Intensive Care Units managed by anesthesiologists: a French national survey

“…In a recent worldwide audit of ICUs 13% of 9 524 included patients had a decision to withhold or withdraw life-sustaining treatment (1). Among 50% of death occurring in ICU, are secondary to a decision of withholding or withdrawal (WW) life support because of futility (2). Several ways to manage end of delivery sustaining therapies, have been described (3,4).…”