Causes and Characteristics of Death in Intensive Care Units
Author:
Orban Jean-Christophe1, Walrave Yannick1, Mongardon Nicolas1, Allaouchiche Bernard1, Argaud Laurent1, Aubrun Frédéric1, Barjon Geneviève1, Constantin Jean-Michel1, Dhonneur Gilles1, Durand-Gasselin Jacques1, Dupont Hervé1, Genestal Michèle1, Goguey Chloé1, Goutorbe Philippe1, Guidet Bertrand1, Hyvernat Hervé1, Jaber Samir1, Lefrant Jean-Yves1, Mallédant Yannick1, Morel Jerôme1, Ouattara Alexandre1, Pichon Nicolas1, Guérin Robardey Anne-Marie1, Sirodot Michel1, Theissen Alexandre1, Wiramus Sandrine1, Zieleskiewicz Laurent1, Leone Marc1, Ichai Carole1,
Affiliation:
1. From the Réanimation Polyvalente et Surveillance Continue, Hôpital Pasteur 2, Centre Hospitalier Universitaire de Nice, Nice, France (J.-C.O., Y.W., C.I.); Service d’Anesthésie et des Réanimations Chirurgicales, Hôpitaux Universitaires Henri Mondor, Assistance Publique–Hôpitaux de Paris, Créteil, France (N.M., G.D.); Département d’Anesthésie-Réanimation, Hôpital Edouard-Herriot, Hospices Civils d
Abstract
Abstract
Background
Different modes of death are described in selected populations, but few data report the characteristics of death in a general intensive care unit population. This study analyzed the causes and characteristics of death of critically ill patients and compared anticipated death patients to unexpected death counterparts.
Methods
An observational multicenter cohort study was performed in 96 intensive care units. During 1 yr, each intensive care unit was randomized to participate during a 1-month period. Demographic data, characteristics of organ failures (Sequential Organ Failure Assessment subscore greater than or equal to 3), and organ supports were collected on all patients who died in the intensive care unit. Modes of death were defined as anticipated (after withdrawal or withholding of treatment or brain death) or unexpected (despite engagement of full-level care or sudden refractory cardiac arrest).
Results
A total of 698 patients were included during the study period. At the time of death, 84% had one or more organ failures (mainly hemodynamic) and 89% required at least one organ support (mainly mechanical ventilation). Deaths were considered unexpected and anticipated in 225 and 473 cases, respectively. Compared to its anticipated counterpart, unexpected death occurred earlier (1 day vs. 5 days; P< 0.001) and had fewer organ failures (1 [1 to 2] vs. 1 [1 to 3]; P< 0.01) and more organ supports (2 [2 to 3] vs. 1 [1 to 2]; P< 0.01). Withdrawal or withholding of treatments accounted for half of the deaths.
Conclusions
In a general intensive care unit population, the majority of patients present with at least one organ failure at the time of death. Anticipated and unexpected deaths represent two different modes of dying and exhibit profiles reflecting the different pathophysiologic underlying mechanisms.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Anesthesiology and Pain Medicine
Cited by
66 articles.
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