Active management of the dying patient.
OBJECTIVE
To document the process of managing the dying patient in the intensive care unit (ICU) and thus to broaden community debate about an issue that is usually only discussed at a theoretical or philosophical level.


METHODS
A six-bed ICU in Liverpool Hospital, a 419-bed teaching institution in the southwestern area of Sydney.


METHODS
Twenty-seven patients, seen over a nine-month period, who had curative treatment withdrawn or withheld. The mean age of the patients was 68 years and the severity of illness, by the APACHE II scoring system, ranged from 12 to 45.


METHODS
Twenty-three of the 27 patients were mechanically ventilated and 11 were receiving inotropic support. Medical staff usually initiated discussions and sought staff consensus that the patient should be allowed to die (on 23 of 27 occasions). Most relatives (25 of 27) accepted this decision. Support therapies and routine care were stopped according to policy guidelines. Sedatives and narcotics were used in some patients (18 of 27). Twenty-one patients died in the ICU and six in the general ward areas.


CONCLUSIONS
Introduction of a policy to guide management of dying patients in intensive care has been accepted by staff. Most dying patients are now managed in accordance with these guidelines. Further discussion and debate of this important issue, by health professionals and society as a whole, is required.
Daffurn
K
K
Department of Anaesthetics and Intensive Care, Liverpool Hospital, NSW.
Kerridge
R
R
Hillman
K M
KM
D000328:Adult; D000368:Aged; D005066:Euthanasia, Passive; D005260:Female; D006745:Hospital Bed Capacity, 300 to 499; D006784:Hospitals, Teaching / Q000458:organization & administration / Q000592:standards*; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007362:Intensive Care Units / Q000592:standards; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D016134:Organizational Policy; D017410:Practice Guidelines as Topic; D012121:Respiration, Artificial; D012720:Severity of Illness Index; D013727:Terminal Care / Q000592:standards*
D006993:Hypnotics and Sedatives