title: End-of-life decisions in intensive care medicine-shared decision-making and intensive care unit length of stay.
abstract: BACKGROUND
  Most deaths on the intensive care unit (ICU) occur after end-of-life decisions (EOLD) have been made. During the decision-making process, responsibility is often shared within the caregiver team and with the patients' surrogates. The intensive care unit length of stay (ICU-LOS) of surgical ICU-patients depends on the primary illness as well as on the past medical history. Whether an increasing ICU-LOS affects the process of EOLD making is unknown.
  
  
  METHODS
  A retrospective analysis was conducted on all deceased patients (n = 303) in a 22-bed surgical ICU of a German university medical center. Patient characteristics were compared between surgical patients with an ICU-LOS up to 1 week and those with an ICU-LOS of more than 7 days.
  
  
  RESULTS
  Deceased patients with a long ICU-LOS received more often an EOLD (83.2% vs. 63.6%, p = 0.001). Groups did not differ in urgency of admission. Attending intensivists participated in every EOLD. Participation of surgeons was significantly higher in patients with a short ICU-LOS (24.1%, p = 0.003), whereas nurses and the patients' surrogates were involved more frequently in patients with a long ICU-LOS (18.8%, p = 0.021 and 18.9%, p = 0.018, respectively).
  
  
  CONCLUSIONS
  EOLDs of surgical ICU-patients are associated with the ICU-LOS. Reversal of the primary illness leads the early ICU course, while in prolonged ICU-LOS, the patients' predicted will and the expected post-ICU-quality of life gain interest. Nurses and the patients' surrogates participate more frequently in EOLDs with prolonged ICU-LOS. To improve EOLD making on surgical ICUs, the ICU-LOS associated participation of the different decision makers needs further prospective analysis.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Campus Charité Mitte and Campus Virchow-Klinikum, Berlin, Germany, jan.graw@charite.de.
authors.forename: Jan A
authors.initials: JA
authors.lastname: Graw
authors.forename: Claudia D
authors.initials: CD
authors.lastname: Spies
authors.forename: Felix
authors.initials: F
authors.lastname: Kork
authors.forename: Klaus-D
authors.initials: KD
authors.lastname: Wernecke
authors.forename: Jan-Peter
authors.initials: JP
authors.lastname: Braun
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003657:Decision Making; D005190:Family; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D024802:Nurse's Role; D010819:Physician's Role; D011788:Quality of Life; D016414:Resuscitation Orders; D012189:Retrospective Studies; D013727:Terminal Care; D013997:Time Factors; D028761:Withholding Treatment