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Futility-of-care decisions in the treatment of moribund intensive care patients in a developing country

L’acharnement thérapeutique pour des moribonds à l’unité des soins intensifs dans un pays en développement

Abstract

Purpose

To analyze the characteristics of moribund patients in a surgical intensive care unit (ICU) and highlight the dilemmas inherent in treating such patients.

Methods

Data on all patients admitted to the surgical ICU during the period of three years from July 1999 to June 2002 were collected prospectively. Data were collected on very ill patients who died, in whom it appeared obvious that treatment could not have improved their condition and whose death could have been anticipated. The case notes were subjected to further analysis to determine the difficulties encountered in managing patients whose therapy was considered to be futile.

Results

Of 662 admissions, 100 (15.1%) died and 30 (4.5%) patients were treated aggressively, even after a prognosis which reflected futile treatment. The overall mean length of stay for survivors was 7.5 ± 9.0 [standard deviation (SD)] days and that for the non-survivors was 12.8 ± 18.1 (SD;P < 0.001). The cost incurred for the treatment of non-survivors was significantly higher than that for the surviving patients. The factors relating to the decisions to continue futile therapy were age of the patient, legal considerations, family wishes and differing opinions between treating physicians.

Conclusion

Consideration of futility during end-of-life care did not receive adequate attention in this unit which incurred additional human and material resources.

Résumé

Objectif

Analyser les caractéristiques des patients moribonds d’une unité de soins intensifs chirurgicaux (USI) et souligner les dilemmes inhérents au traitement de ces patients.

Méthode

Nous avons rassemblé prospectivement les données concernant tous les patients admis à l’USI chirurgicaux de juillet 1999 à juin 2002. Nous avons gardé les données sur des patients gravement malades qui sont décédés, pour qui il est apparu évident que le traitement n’avait pas amélioré la condition et dont la mort pouvait être prévue Les informations ont été ensuite soumises à une analyse supplémentaire afin de préciser les difficultés de prise en charge de ces patients dont le traitement était considéré inutile.

Résultats

Des 662 patients admis, 100 (15,1 %) sont décédés et 30 (4,5 %) ont reçu un traitement énergique, même après un pronostic qui révélait l’inutilité du traitement. La moyenne globale de la longueur du séjour hospitalier des survivants a été de 7,5 ± 9,0 jours [écart type] et celle des non survivants a été de 12,8 ± 18,1 jours (écart type; P < 0,001). Le coût du traitement des non survivants a été significativement plus élevé que celui des survivants. Les facteurs qui ont amené à poursuivre un traitement inutile étaient l’âge du patient, des préoccupations légales, des demandes de la famille et des divergences d’opinions entre les médecins traitants.

Conclusion

On ne se préoccupe pas suffisamment de l’inutilité des soins aux personnes en fin de vie à l’USI chirurgicaux, ce qui entraîne l’utilisation de ressources humaines et matérielles supplémentaires.

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Correspondence to Seetharaman Hariharan.

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Hariharan, S., Moseley, H.S.L., Kumar, A.Y. et al. Futility-of-care decisions in the treatment of moribund intensive care patients in a developing country. Can J Anesth 50, 847–852 (2003). https://doi.org/10.1007/BF03019385

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Keywords

  • Intensive Care Unit Care
  • Queen Elizabeth Hospital
  • Medical Futility
  • Critical Care Nurse
  • Moribund Patient