Futility-of-care decisions in the treatment of moribund intensive care patients in a developing country.
OBJECTIVE
To analyze the characteristics of moribund patients in a surgical intensive care unit (ICU) and highlight the dilemmas inherent in treating such patients.


METHODS
Data on all patients admitted to the surgical ICU during the period of three years from July 1999 to June 2002 were collected prospectively. Data were collected on very ill patients who died, in whom it appeared obvious that treatment could not have improved their condition and whose death could have been anticipated. The case notes were subjected to further analysis to determine the difficulties encountered in managing patients whose therapy was considered to be futile.


RESULTS
Of 662 admissions, 100 (15.1%) died and 30 (4.5%) patients were treated aggressively, even after a prognosis which reflected futile treatment. The overall mean length of stay for survivors was 7.5 +/- 9.0 [standard deviation (SD)] days and that for the non-survivors was 12.8 +/- 18.1 (SD; P < 0.001). The cost incurred for the treatment of non-survivors was significantly higher than that for the surviving patients. The factors relating to the decisions to continue futile therapy were age of the patient, legal considerations, family wishes and differing opinions between treating physicians.


CONCLUSIONS
Consideration of futility during end-of-life care did not receive adequate attention in this unit which incurred additional human and material resources.
Hariharan
Seetharaman
S
Department of Anaesthesia, Surgery and Surgical Intensive Care, Queen Elizabeth Hospital, Barbados, West Indies. hariharan@sunbeach.net
Moseley
Harley S L
HS
Kumar
Areti Y
AY
Walrond
Errol R
ER
Jonnalagadda
Ramesh
R
D018806:APACHE; D000367:Age Factors; D000368:Aged; D001460:Barbados; D001926:Brain Death; D003243:Consciousness; D003422:Critical Care / Q000191:economics / Q000331:legislation & jurisprudence; D003906:Developing Countries; D005190:Family; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D018447:Medical Futility / Q000331:legislation & jurisprudence; D018458:Persistent Vegetative State; D011446:Prospective Studies; D006435:Renal Dialysis; D016414:Resuscitation Orders / Q000331:legislation & jurisprudence; D013534:Survival; D017741:Survivors; D016896:Treatment Outcome