Resuscitative status of patients during their stay in the ICU: changing decision-making to end-of-life care

Objective

To verify whether the status of treatment in terms of resuscitative effort changes during the stay of critical patients in intensive care.

Methods

We retrospectively analyzed 2108 patients admitted to the ICU from 1 January 2003 to 31 December 2003. During this period, the resuscitative status (no limitation of care, do not resuscitate and comfort care) at the moment of admission and in the morning medical visit on the day of death were recorded and compared. Numerical variables were compared using the Student t test and categorical variables with the chi-square test. A level of significance of 5% was required to consider some difference as significant.

Results

Death occurred in 204 (9.7%) patients and dead patients were older (69.2 ± 17.6 vs 63.1 ± 18.5 years, P < 0.001) and had a longer stay in the ICU (45 ± 13.8 vs 4 ± 8.3 days, P < 0,001) than the total admission patients. The APACHE score was not different (20.1 vs 21.2, P = 0.06). The resuscitative status is presented in Table 1.

Table 1 Resuscitative status at admission and on the day of death

Conclusion

The change of the resuscitative status from admission to the day of death may reflect a change in the medical decision, involving the families, to end-of-life care, limiting measures that prolong life after failure of intensive support.