Causes of death and determinants of outcome in critically ill patients

Mayr, Viktoria D.; Dünser, Martin W.; Greil, Veronika; Jochberger, Stefan; Luckner, Günter; Ulmer, Hanno; Friesenecker, Barbara; Takala, Jukka; Hasibeder, Walter

doi:10.1186/cc5086

Cited by 190 publications

(78 citation statements)

References 49 publications

(35 reference statements)

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“…Causes of death recorded on death certificates are notoriously inaccurate and do not have a standard format [12,13]. In one large study by Mayr et al [14], the reason for death was determined in 3700 critically ill patients, a minority of whom had been admitted with sepsis. In that study, the most common reason for death was acute, refractory multiorgan dysfunction defined as at least 4 failing organs, mean arterial pressure less than 60, and a metabolic derangement (eg, lactate elevation).…”

Section: Discussionmentioning

confidence: 99%

Reasons for death in patients with sepsis and septic shock

Moskowitz

Omar

Chase

et al. 2017

Journal of Critical Care

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Purpose sepsis has broad implications for both clinical care and interventional trial design. However, reasons for death in sepsis remain poorly understood. We sought to characterize reasons for in-hospital mortality in a population of patients with sepsis or septic shock. Materials and methods We performed a retrospective review of patients admitted to the intensive care unit with sepsis or septic shock who died during their index admission. Reasons for death were classified into 6 categories determined a priori by group consensus. Interrater reliability was calculated and Fleiss κ reported. The associations between selected patient characteristics (eg, serum lactate) and reason for death were also assessed. Results One hundred fifteen patients were included. Refractory shock (40%) and comorbid withdrawal of care (44%) were the most common reasons for death. Overall interrater agreement was substantial (κ = 0.61, P < .01). Lactate was higher in patients who died because of refractory shock as compared with those who died for other reasons (4.7 vs 2.8 mmol/L, P < .01). Conclusion In this retrospective cohort, refractory shock and comorbid withdrawal of care were the most common reasons for death. Following prospective validation, the classification methodology presented here may be useful in the design/interpretation of trials in sepsis.

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Section: Discussionmentioning

confidence: 99%

Reasons for death in patients with sepsis and septic shock

Moskowitz

Omar

Chase

et al. 2017

Journal of Critical Care

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“…The vast majority of deaths occur after a prolonged hospital course complicated by multiple organ failure with alternating periods of improvement and deterioration (9, 11). Patients on this course may move back and forth between the surgical floor and ICU (12, 17). Initially, these patients are often indistinguishable from those who ultimately survive with increasing clarification of their eventual outcome coming only after an extended time of prognostic uncertainty.…”

Section: Surgical Critical Illnessmentioning

confidence: 99%

Integrating palliative care in the surgical and trauma intensive care unit

Mosenthal

Weissman

Curtis

et al. 2012

Critical Care Medicine

149

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Objective Although successful models for palliative care delivery and quality improvement in the intensive care unit have been described, their applicability in surgical intensive care unit settings has not been fully addressed. We undertook to define specific challenges, strategies, and solutions for integration of palliative care in the surgical intensive care unit. Data Sources We searched the MEDLINE database from inception to May 2011 for all English language articles using the term “surgical palliative care” or the terms “surgical critical care,” “surgical ICU,” “surgeon,” “trauma” or “transplant,” and “palliative care” or “end-of- life care” and hand-searched our personal files for additional articles. Based on review of these articles and the experiences of our interdisciplinary expert Advisory Board, we prepared this report. Data Extraction and Synthesis We critically reviewed the existing literature on delivery of palliative care in the surgical intensive care unit setting focusing on challenges, strategies, models, and interventions to promote effective integration of palliative care for patients receiving surgical critical care and their families. Conclusions Characteristics of patients with surgical disease and practices, attitudes, and interactions of different disciplines on the surgical critical care team present distinctive issues for intensive care unit palliative care integration and improvement. Physicians, nurses, and other team members in surgery, critical care and palliative care (if available) should be engaged collaboratively to identify challenges and develop strategies. “Consultative,” “integrative,” and combined models can be used to improve intensive care unit palliative care, although optimal use of trigger criteria for palliative care consultation has not yet been demonstrated. Important components of an improvement effort include attention to efficient work systems and practical tools and to attitudinal factors and “culture” in the unit and institution. Approaches that emphasize delivery of palliative care together with surgical critical care hold promise to better integrate palliative care into the surgical intensive care unit.

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“…One study indicates that 6.4% to 40% death occur among critically ill patients in ICUs [16]. In two large multicenter studies, ICU mortality was estimated 12.4% in 38,000 and 16.6% in 17,000 patients [17].…”

Section: Discussionmentioning

confidence: 99%

One Year Survival and Quality of Life in Patients Successfully Discharged From Neuro Critical Care Unit

Poursadeghfard

Bastani

Poursadeghfard

et al. 2017

IRJ

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Objectives: Neuro-critical Intensive Care Units (NICUs) have functioned to deliver intensive medical care services for patients with acute neurology problems. However, physicians and ICU staff do not have any feedback about their patients and their abilities after successful discharge. Various studies have documented short-term survival in ICUs, but the long-term outcome and quality of life (QOL) are less studied.Methods: This is a retrospective cohort study over a period of one year from February 2011 to February 2012 (Shiraz, South of Iran). Patients' charts were used to collect the data. Survival and QOL after one year following NICU admission were assessed for surviving patients by a telephone interview with patients or their family members using Karnofsky Performance Scale (KPS). Results:Out of 93 patients, 42(45.2%) were male, and 51(54.8%) were female. Malignant ischemic stroke (34%) was the most common cause followed by Guillain Barre Syndrome (21%). Among the living successfully discharged patients, 45% were able to perform normal activity and work without any special assistance. The patients who were unable to work were 28%, but they were able to live at home and care for their most personal needs. The patients who were unable to care for themselves were 3% and required institutional or hospital care. Over one year following discharge, 24% patients were passed away.Discussion: is lower in NICU survivors compared with general population; however, if patients' selection and out of hospital care are done appropriately and continuously, more patients can live independently or even come back to their work. Indeed, it is important to identify patients who benefit more from NICU during decision making for ICU admission. As a result, more efficient rehabilitation could be achieved in the future. However, our conclusions are only related to our ward and do not apply to the total population of critical neurology patients.

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Causes of death and determinants of outcome in critically ill patients

Abstract: Introduction Whereas most studies focus on laboratory and clinical research, little is known about the causes of death and risk factors for death in critically ill patients.

Cited by 190 publications

References 49 publications

Reasons for death in patients with sepsis and septic shock

Reasons for death in patients with sepsis and septic shock

Integrating palliative care in the surgical and trauma intensive care unit

One Year Survival and Quality of Life in Patients Successfully Discharged From Neuro Critical Care Unit

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