Dying in the Intensive Care Unit

Abstract

Objective: To document (using available data) the profile of the patients seen by the hospital’s palliative service (PS) and who died in the medicine intensive care unit (ICU) of the Veterans Affairs Caribbean Healthcare System. Methods: A record review of subjects who died in the ICU from January 1, 2012, to December 31, 2014. Demographic data, underlying comorbidities, the cause of death, the length of stay, evaluation made by the PS, and the withdrawal of life support (when such occurred) were recorded for each patient. Results: A total of 200 patients met the criteria, mostly males. All the women and 50% of the men were over 79 years old. Seventy three percent of the patients were on mechanical ventilation when admitted, most having come from the emergency department. Fewer than 15% had advance directives. Forty-nine percent had been admitted to a hospital facility at least once during the year prior to their current admission. Most of the patients (60.5%) died within the first week, while 13% died within the first 24 hours. PS was requested for 56% of those who survived more than 24 hours, of which only 10% underwent the withdrawal-of-care protocol. Conclusion: A small percentage of the patients who died in the ICU had advance directives at the time of admission, this though all were of advanced age, had recently been discharged after a prior hospital stay, suffered from 1 or more chronic illnesses, or had a history of mental or physical disease. Our findings underscore the need for the early referral of patients of the type previously mentioned to a PS.