The goal of the critical care team has traditionally been to save patients at all costs. In the last fifteen years, however, it has been increasingly recognized that a second, equally important goal is to relieve suffering and help patients have a dignified death. We reviewed Medical Intensive Care Unit (MICU) mortality to determine how well we were meeting both goals.
MICU mortality in 1990 was compared to that of 2003. Length of MICU stay, patient demographics, APACHE II Scores, use of “DO-NOT-RESUSCITATE (DNR)” orders and witholding or withdrawal of care were compared.
The total number of MICU admissions in 1990 was 868 with 130 deaths (15%) while in 2003 there were 966 admissions with 126 deaths (13%). Thirty-nine patients (30%) died within the first 24 hours in 1990 compared to 48 (38%) in 2003 (P=0.05). The average age of the patients rose from 76 (±12) in 1990 to 83 (±15) in 2003. Overall 29% of 1990 patients had a DNR order compared to 41% in 2003 (P=0.05). The average APACHE II Score was similar in both groups. Amongst non-survivors, DNRs were ordered in 56% in 1990 versus 60% in 2003. DNRs were issued in 62% of those with 24-hour mortality in 1990 versus 88% in 2003 (P=0.05). Withdrawing or witholding of therapy was employed in 9% of 1990 patients as compared to 22% of 2003 patients (P=0.01). Care was witheld or withdrawn in 32% of non-survivors in 1990 versus 77% in 2003 (P=0.001).
Overall MICU mortality remained constant over the fifteen-year period. The proportion of patients for whom care was withdrawn or witheld has significantly increased.
Palliative care is increasingly important in the care of critically ill patients.
N. Awan, None.