Advertisement

End-of-Life Care in the Intensive Care Unit: Toward a New Concept of Futility

  • D. Crippen

Abstract

A high proportion of patients who die in hospitals do so in some form of intensive care unit (ICU) [1]. As medical care is made available to growing populations, the number of patients who develop critical illness increases. Accordingly, more titrated treatment needs to be provided, in an environment that facilitates such care. Normally, only patients with a strong potential to benefit from the services of an ICU are admitted to one [2]. In a perfect system, no one would die in an ICU, except as a result of an unexpected decompensation [3]. Many intensivists believe that patients who fail to respond to intensive care should be quickly transferred to home or hospice to die [4].

Keywords

Intensive Care Unit Critical Care Intensive Care Unit Patient Organ System Failure Critical Care Physician 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Dragsted L, Qvist J (1992) Epidemiology of intensive care. Int J Technol Assess Health Care 8: 395–407PubMedCrossRefGoogle Scholar
  2. 2.
    Wu AW, Damian AM, Lynn J, et al (1995) Predicting future functional status for seriously ill hospitalized adults. The SUPPORT prognostic model. Ann Intern Med 122: 342–350PubMedCrossRefGoogle Scholar
  3. 3.
    Teno JM, Fisher E, Hamel MB, et al (2000) Decision-making and outcomes of prolonged ICU stays in seriously ill patients. J Am Geriatr Soc 48: S70 - S274PubMedGoogle Scholar
  4. 4.
    Lynn J, Harrell F Jr, Cohn F, Wagner D, Connors AF Jr (1997) Prognoses of seriously ill hospitalized patients on the days before death: implications for patient care and public policy. New Horiz 5: 56–61PubMedGoogle Scholar
  5. 5.
    Prendergast TJ (1997) Resolving conflicts surrounding end-of-life care. New Horiz 5: 62–71PubMedGoogle Scholar
  6. 6.
    Cassell EJ (1986) Autonomy in the intensive care unit: the refusal of treatment. Crit Care Clin 2: 27–40PubMedGoogle Scholar
  7. 7.
    Fama AJ (1980) Classification of critically ill patients: a legal examination. St Louis Univ Law J 24: 514–533PubMedGoogle Scholar
  8. 8.
    Teres D (1993) Trends from the United States with end of life decisions in the intensive care unit. Intensive Care Med 19: 316–322PubMedCrossRefGoogle Scholar
  9. 9.
    Burrows R (1994) Removal of life support in intensive care units. Med Law 13: 489–500PubMedGoogle Scholar
  10. 10.
    Crippen D, Levy M, Truog R, Whetatine L, Luce J (2000) Debate: what constitutes ‘terminality’ and how does it relate to a living will? Crit Care 4: 333–338PubMedCrossRefGoogle Scholar
  11. 11.
    Yeager AL (2002) On Hippocrates. Either help or do not harm the patient. Br Med J 325: 496CrossRefGoogle Scholar
  12. 12.
    Truog RD (1999) Death: merely biological? Hastings Cent Rep 29: 4PubMedGoogle Scholar
  13. 13.
    Kelly DF (2002) Medical futility in American health care. In: Crippen D, Kilcullen JK, Kelly DF (eds) Three Patients: International Perspective on Intensive Care at the End of Life. Kluwer Academic Publishers, Boston, pp 7–23Google Scholar
  14. 14.
    Engelhardt HT Jr, Rie MA (1986) Intensive care units, scarce resources, and conflicting principles of justice. JAMA 255: 1159–1164PubMedCrossRefGoogle Scholar
  15. 15.
    Scheffler R (1982) Severity of illness and the relationship between intensive care and survival. Am J Public Health 72: 449–454PubMedCrossRefGoogle Scholar
  16. 16.
    Detsky AS, Stricker SC, Mulley AG, Thibault GE (1981) Prognosis, survival, and the expenditure of hospital resources for patients in an intensive-care unit. N Engl J Med 305: 667–672PubMedCrossRefGoogle Scholar
  17. 17.
    Pronovost P, Angus DC (2001) Economics of end-of-life care in the intensive care unit. Crit Care Med 29: N46 - N51PubMedCrossRefGoogle Scholar
  18. 18.
    Angus DC, Sirio CA, Clermont G, Bion J (1997) International comparisons of critical care outcome and resource consumption. Grit Care Clin 13: 389–407CrossRefGoogle Scholar
  19. 19.
    Chelluri L, Pinsky MR, Donahoe MP (1993) Long-term outcome of critically ill elderly patients requiring intensive care. JAMA 269: 3119–3123PubMedCrossRefGoogle Scholar
  20. 20.
    Crippen D (2002) Discussion of the medical aspects of futility. In: Crippen D, Kilcullen JK, Kelly DF (eds) Three Patients: International Perspective on Intensive Care at the End of Life. Kluwer Academic Publishers, Boston, pp 189–203Google Scholar
  21. 21.
    Vincent JL (1998) Information in the ICU: are we being honest with our patients? The results of a European questionnaire. Intensive Care Med 24: 1251–1256PubMedCrossRefGoogle Scholar
  22. 22.
    Crippen D (1999) Regionalization, prioritization, and sailing ships in the year 2010. New Horiz 7: 218–228Google Scholar
  23. 23.
    Crippen D (2000) The devolution of critical care in the U.S. Cost Qual 6: 17–19PubMedGoogle Scholar
  24. 24.
    Daniels N (1986) Why saying no to patients in the United States is so hard: cost containment, justice, and provider autonomy. N Engl J Med 314: 1380–1383PubMedCrossRefGoogle Scholar
  25. 25.
    Crippen D, Whetstine L (1999) ICU resource allocation: life in the fast lane. Grit Care (Lond) 3: R47 - R51CrossRefGoogle Scholar
  26. 26.
    Weiser B (1983) As they lay dying, part 1: The doctor’s agony: deciding to end life-saving therapy. Washington Post April 17:Al-A16Google Scholar
  27. 27.
    Crippen D (2000) Life-threatening brain failure and agitation in the intensive care unit. Crit Care 4: 81–90PubMedCrossRefGoogle Scholar
  28. 28.
    Szokol JW, Vender JS (2001) Anxiety, delirium, and pain in the intensive care unit. Grit Care Clin 17: 821–842CrossRefGoogle Scholar
  29. 29.
    Crippen D (1995) Understanding the neurohumoral causes of anxiety in the ICU: clinical consequences include agitation, brain failure, delirium. J Crit Illn 10:550–555, 559–560Google Scholar
  30. 30.
    Donchin Y, Seagull FJ (2002) The hostile environment of the intensive care unit. Curr Opin Crit Care 8: 316–320PubMedCrossRefGoogle Scholar
  31. 31.
    Van den Berghe G (2002) Neuroendocrine pathobiology of chronic critical illness. Crit Care Clin 18: 509–528PubMedCrossRefGoogle Scholar
  32. 32.
    Scragg P, Jones A, Fauvel N (2001) Psychological problems following ICU treatment. Anaesthesia 56: 9–14PubMedCrossRefGoogle Scholar
  33. 33.
    Jones C, Griffiths RD, Humphris G, Skirrow PM (2001) Memory, delusions, and the development of acute posttraumatic stress disorder-related symptoms after intensive care. Crit Care Med 29: 573–580PubMedCrossRefGoogle Scholar
  34. 34.
    Stoll C, Kapfhammer HP, Rothenhausler HB, et al (1999) Sensitivity and specificity of a screening test to document traumatic experiences and to diagnose post-traumatic stress disorder in ARDS patients after intensive care treatment. Intensive Care Med 25: 697–704PubMedCrossRefGoogle Scholar
  35. 35.
    Dunstan GR (1985) Hard questions in intensive care. A moralist answers questions put to him at a meeting of the Intensive Care Society, Autumn, 1984. Anaesthesia 40: 479–482PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • D. Crippen

There are no affiliations available

Personalised recommendations