Causes and consequences of disproportionate care in intensive care medicine.
OBJECTIVE
Increased use of advanced life-sustaining measures in patients with poor long-term expectations secondary to more chronic organ dysfunctions, comorbidities and/or a poor quality of life has become a worrying trend over the last decade. This can lead to futile, disproportionate or inappropriate care in the ICU. This review summarizes the causes and consequences of disproportionate care in the ICU.


RESULTS
Disproportionate care seems to be common in European and North American ICUs. The initiation and prolongation of disproportionate care can be related to hospital facilities, healthcare providers, the patient and his/her representatives and society. This can have serious consequences for patients, their relatives, physicians, nurses and society.


CONCLUSIONS
Disproportionate care is common in western ICUs. It can lead to violation of basic bioethical principles, suffering of patients and relatives and compassion fatigue and moral distress in healthcare providers. Avoiding inappropriate use of ICU resources and disproportionate care in the ICU should have high priority for ICU managers but also for every healthcare provider taking care of patients at the bedside.
aErasmus MC University Medical Center Rotterdam, Department of Intensive Care Medicine, Rotterdam, The Netherlands bDepartment of Geriatrics, Ghent University Hospital cDepartment of Intensive Care, Medical Unit Ghent University Hospital, Ghent, Belgium.
Erwin J O
EJ
Kompanje
Ruth D
RD
Piers
Dominique D
DD
Benoit
D001291:Attitude of Health Personnel; D003422:Critical Care / Q000941:ethics*; D003657:Decision Making; D005066:Euthanasia, Passive / Q000941:ethics / Q000523:psychology; D005190:Family / Q000523:psychology; D005260:Female; D006801:Humans; D007362:Intensive Care Units / Q000941:ethics; D008297:Male; D010817:Physician-Patient Relations; D010820:Physicians / Q000941:ethics / Q000523:psychology*; D011788:Quality of Life; D016414:Resuscitation Orders