Interdisciplinary ethics consultation on the surgical ICU: indication 'on a gut level'?

Introduction

Interdisciplinary ethics consultation (EC) on the ICU can be requested by the clinical team as a result of a subjective assessment of the patient's situation. The aim of this study was to objectify the initiation of EC by means of the SOFA score and to examine its impact on the clinical course.

Methods

Over a 2-year period, all patients receiving an EC on the ICU were recorded. The age, hospital stay and mortality were compared with ICU patients who did not receive an EC. SOFA score values of EC patients at the time of admission to the ICU and at the time of EC were compared. Furthermore, the effect of different EC decisions (maximization/limitation of treatment) on hospital stay and mortality were defined.

Results

An EC was carried out in 52 patients out of the total 764 patients (6.8%). Age (76.6 years; range 40–99), hospital stay (20.5 days; range 5–286) and ICU mortality (92.3%) were significantly higher in EC patients compared with patients without EC (68.3 years; range 10–100; P ≤ 0.001) (3 days; range 2–106; P ≤ 0.001) (7.6%; P ≤ 0.001). The mean SOFA score at the time of EC (7.52; ± 0.48 SEM) was significantly higher compared with the time of admission to the ICU (4.29; ± 0.42 SEM) (P ≤ 0.001). Following maximization of treatment (n = 9), the median hospital stay was significantly longer (13 days; range 4–254) compared with other EC decisions (n = 43) (P ≤ 0.007).

Conclusion

In critically ill patients, the interdisciplinary EC provides a meaningful tool for decision-making between maximization and reduction of treatment – facilitating improved end of life care and dignified dying. Indication of an EC at the bedside should be supported by the SOFA score.