End-of-life management in intensive care units: a multicentre observational prospective cohort study

The study was conducted to evaluate intensive care unit (ICU) patients that ultimately died but could have met criteria for end-of-life management/palliative care (ELM-PC), and to analyse the application of components of palliative care, either "unperformed procedures" or elements of "...

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Bibliographic Details
Published in:Anaesthesiology intensive therapy : official publication of the Polish Society of Anaesthesiology and Intensive Therapy 2019-01, Vol.51 (5), p.348-356
Main Authors: Alliprandini, Marina, Ferrandin, Andressa, Fernandes, Adriana, Belim, Mariana, Jorge, Mariana, Colombo, Bruno, Yaguchi, Jordana, Chung, Thais, Jorge, Amaury, Duarte, Pericles
Format: Article
Language:English
Subjects:
Acute coronary syndromes
Catheters
Cohort analysis
death
Death & dying
Health care
Hospitals
Intensive care
intensive care unit
Mortality
Palliative care
patient comfort
Patients
Quality of life
Researchers
Teams
Verbal communication
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Summary:The study was conducted to evaluate intensive care unit (ICU) patients that ultimately died but could have met criteria for end-of-life management/palliative care (ELM-PC), and to analyse the application of components of palliative care, either "unperformed procedures" or elements of "futile/unnecessary treatment". An observational prospective cohort in five ICUs in Southern Brazil. Adult patients who died were evaluated, searching for criteria for ELM-PC. The correct application of nine preselected items by the ICU team was studied. Among 253 admissions, 52 patients died; among these, 38.5% met criteria for ELM-PC. Among ELM-PC candidates (n = 20), the ELM-PC was started later (after day 3) in 60%, and only three patients received adequate palliative care. "Analgesia" and "daily family interviews" were the most correctly applied ELM-PC elements. "Terminal extubation/weaning" was not performed in any of the patients. A reduction in the lifespan from the onset of ELM-PC to death was observed in patients who underwent "correct" interventions - 66.6% died on the first day of ELM-PC. In a patient cohort from a low-medium-income country, one-third of patients who died in the ICU had criteria (indications) for ELM-PC; however, the palliative care was adequately performed for only 15% of patients, with great heterogeneity and delays regarding its initiation.
ISSN:1642-5758
1731-2531
DOI:10.5114/ait.2019.91189