title: Some are old, some are new: life and death in the ICU.
abstract: We compared 560 adults hospitalized in our Medical Intensive Care Unit (MICU) to 245 ventilated babies hospitalized in our Neonatal ICU (NICU). Both ICUs had comparable mortality rates--roughly 1 patient in 5 died. The average length of hospitalization for nonsurvivors versus survivors was disproportionately short for NICU babies (13d v 33d) and long for MICU adults (15d v 12d). This phenomenon resulted in a redistribution of ICU bed-days and resources in favor of survivors for NICU babies (approximately 9 of every 10 NICU beds were devoted to babies who survived), and nonsurvivors for MICU adults (roughly 1 MICU bed in 2). Both ICUs had comparable percentages of patients predicted to die--roughly 1 patient in 3. The predictive power of an intuition of die was comparable--and not all that great. Almost one third of patients in both ICUs with a single prediction of "die in hospital" survived to be discharged. However, the likelihood of finding a neurologically normal NICU survivor after a prediction of "die" was only 5 in 100. To the extent that informed decisions can be made with 95% certainty, we may have found a foothold on the slippery ethical slope of benefit/burden calculations in the NICU. Unfortunately, we have no comparable data for MICU survivors.
authors.affiliation: Department of Pediatrics and Critical Care Medicine, MacLean Center for Clinical Medical Ethics, The University of Chicago, Chicago, IL 60637, USA. WLM1@midway.uchicago.edu
authors.forename: William
authors.initials: W
authors.lastname: Meadow
authors.forename: Jesse
authors.initials: J
authors.lastname: Hall
authors.forename: Laura
authors.initials: L
authors.lastname: Frain
authors.forename: Yaya
authors.initials: Y
authors.lastname: Ren
authors.forename: Anne
authors.initials: A
authors.lastname: Pohlman
authors.forename: Susan
authors.initials: S
authors.lastname: Plesha-Troyke
authors.forename: Winnifred
authors.initials: W
authors.lastname: Gresens
authors.forename: John
authors.initials: J
authors.lastname: Lantos
mesh_terms: D000328:Adult; D004992:Ethics, Medical; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D015931:Intensive Care, Neonatal; D009017:Morbidity; D009026:Mortality; D011379:Prognosis