Abstract
End-of-life management in intensive care units: a multicentre observational prospective cohort study
- Hospital Universitario do Oeste do Parana, Cascavel, Parana, Brazil
- Hospital Sao Lucas – FAG, Cascavel, Parana, Brazil
- General ICU, Hospital Universitario do Oeste do Parana, Cascavel, Parana, Brazil
- Hospital do Cancer/UOPECCAN, Cascavel, Parana, Brazil
2019; 51, 5: 354–362
Backgrounds
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”.
Methods
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.
Results
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.
Conclusions
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.
Keywords
palliative care, intensive care unit, death, patient comfort