- Oral presentation
- Open Access
Palliative Care Team Consultation: Circumstances Surrounding Patients Deaths At The Icu
© Biselli-Ferreira et al.; 2015
- Published: 1 October 2015
- Intensive Care Unit
- Intensive Care Unit Patient
- Life Support
- Advanced Directive
- Advanced Life Support
Previous studies reported that patients in end-of-life (EOL) care may still receive aggressive treatment in the Intensive Care Unit (ICU). Despite the fact that less than 10% of Americans report that they would be willing to die in the hospital, up to 45% may ultimately do so. a significant fraction will perish in a critical care setting, which may represent a deviation from previous patients' values. Therefore, it appears to be crucial to understand the circumstances surrounding the death of patients in end-of-life care, specifically which factors might be associated with decision to transfer or to maintain patients in EOL care in the ICU.
To characterize factors associated with death in the ICU in patients accompanied by a palliative care team (PCT) in a tertiary private hospital in Brazil.
Retrospective analysis of prospectively collected data based on a standardized questionnaire of PCT. All 628 questionnaires from June 2008 to December 2013 were included. Two groups were compared: patients that eventually died in the ICU versus patients that died outside the ICU.
Death at ICU (n = 76)
Death out of ICU (n = 367)
Age,y, median (SD)
Male sex, n (%)
Cancer diagnosis, n (%)
Conflicts, n (%)
Time from referral to PCT until death < 3 days, n (%)
Time from hospital admission until referral to PCT >14 days, n (%)
Receiving advanced support of life (mechanical ventilation or vasoactive drugs), n (%)
Patients were in ICU when referral to PCT, n (%)
With written directives of end-of-life care *, n (%)
Explicit directives of EOL care were more commonly explicitly written in non-ICU patients (26.4% versus 12.3%, p < 0.006). As expected, we also observed that a remarkable percentage of ICU patients received advanced life support until death (42%). There were no association between death in the ICU and age, late PCT consultation (less than 3 days before death) and prolonged hospitalization (hospital length of stay> 14 days at the of the PCT consultation).
Circumstances associated with death in the ICU of patients assisted by PCT included a non-cancer diagnosis, conflicts as reason to referral, being in the ICU or receiving life support at the time of the initiation of PCT consultation, and the lack of written advanced directives of EOL care. Further studies are needed to evaluate whether modifying these circumstances may be related to a different EOL care.
- Khandelwal N, Kross EK, Engelberg RA, Coe NB, Long AC, Curtis JR: Estimating the effect of palliative care interventions and advance care planning on ICU utilization: a systematic review. Crit Care Med. 2015, Jan 9. PMID: 25574794.Google Scholar
This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.