End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study.
BACKGROUND
Death in the intensive care unit is often predictable. End of life management is often discussed and initiated when futility of care appears evident. Respect for patients wishes, dignity in death, and family involvement in the decision-making process is optimal. This goal may often be elusive.


OBJECTIVE
Our purpose was to review the end of life processes and family involvement within our Unit.


METHODS
We conducted a chart audit of all deaths in our 10 bed Unit over a 12-month period, reviewing patient demographics, diagnosis on admission, patient acuity, expectation of death and not-for-resuscitation status. Discussions with the family, treatments withheld and withdrawn and extubation practices were documented. The presence of family or next-of-kin at the time of death, the time to death after withdrawal of therapy and family concerns were recorded.


RESULTS
There were 70 patients with a mean age of 69 years. Death was expected in 60 patients (86%) and not-for-resuscitation was documented in 58 cases (85%). Family discussions were held in 63 cases (90%) and treatment was withdrawn in 34 deaths (49%). After withdrawal of therapies, 31 patients (44%) died within 6h. Ventilatory support was withdrawn in 24 cases (36%). Family members were present at the time of death in 46 cases (66%). Family concerns were documented about the end of life care in only 1 case (1.4%).


CONCLUSIONS
Our data suggests that death in our Unit was often predictable and that end of life management was a consultative process.
Bloomer
Melissa Jane
MJ
Peninsula Health, Continuing Education and Development Unit, Hastings Road, Frankston, VIC 3199, Australia. smakb@ozemail.com.au
Tiruvoipati
Ravindranath
R
Tsiripillis
Michael
M
Botha
John A
JA
D018806:APACHE; D000368:Aged; D002423:Cause of Death; D003422:Critical Care / Q000458:organization & administration*; D003657:Decision Making; D005190:Family / Q000523:psychology; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay / Q000706:statistics & numerical data; D008485:Medical Audit; D018447:Medical Futility; D024802:Nurse's Role; D010166:Palliative Care / Q000458:organization & administration*; D010818:Practice Patterns, Physicians' / Q000458:organization & administration*; D012121:Respiration, Artificial / Q000706:statistics & numerical data; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care / Q000458:organization & administration*; D013997:Time Factors; D014739:Victoria; D028761:Withholding Treatment / Q000706:statistics & numerical data