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Maimonides Medical Center, Brooklyn, NY
PURPOSE: The goal of the critical care team has traditionally been to save patients at all costs. In the last fifteen years, however, it has been increasingly recognized that a second, equally important goal is to relieve suffering and help patients have a dignified death. We reviewed Medical Intensive Care Unit (MICU) mortality to determine how well we were meeting both goals.
METHODS: MICU mortality in 1990 was compared to that of 2003. Length of MICU stay, patient demographics, APACHE II Scores, use of "DO-NOT-RESUSCITATE (DNR)" orders and witholding or withdrawal of care were compared.
RESULTS: The total number of MICU admissions in 1990 was 868 with 130 deaths (15%) while in 2003 there were 966 admissions with 126 deaths (13%). Thirty-nine patients (30%) died within the first 24 hours in 1990 compared to 48 (38%) in 2003 (P=0.05). The average age of the patients rose from 76 (±12) in 1990 to 83 (±15) in 2003. Overall 29% of 1990 patients had a DNR order compared to 41% in 2003 (P=0.05). The average APACHE II Score was similar in both groups. Amongst non-survivors, DNRs were ordered in 56% in 1990 versus 60% in 2003. DNRs were issued in 62% of those with 24-hour mortality in 1990 versus 88% in 2003 (P=0.05). Withdrawing or witholding of therapy was employed in 9% of 1990 patients as compared to 22% of 2003 patients (P=0.01). Care was witheld or withdrawn in 32% of non-survivors in 1990 versus 77% in 2003 (P=0.001).
CONCLUSION: Overall MICU mortality remained constant over the fifteen-year period. The proportion of patients for whom care was withdrawn or witheld has significantly increased.
CLINICAL IMPLICATIONS: Palliative care is increasingly important in the care of critically ill patients.
DISCLOSURE: N. Awan, None.
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