One In Five Americans Die In ICU
 

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By Merritt McKinney
4-15-4

NEW YORK (Reuters Health) - Even though nine out of ten people in the U.S. say they would prefer to die at home, a new study shows that about 20 percent of Americans die in hospital intensive care units.

Researchers say that, while the aim of intensive care units (ICUs) is to keep patients alive, staff members providing intensive care need to be prepared to provide quality end-of-life care, too.

The reasons why such a sizable proportion of Americans die in ICUs "are complex," according to study author Dr. Derek C. Angus at the University of Pittsburgh School of Medicine.

One important reason is uncertainty about a patient's survival odds, he told Reuters Health. Although the ICU may not be where people want to die, they do not want to die in the first place, Angus pointed out.

"That means that they, their families or their doctors pull out all the stops" to try to keep them from dying, he explained. The result is that a lot of people are admitted to the ICU with only a slim hope of survival.

"I think the future could bring better risk prediction models that might allow us to better identify who will or will not benefit from ICU care," Angus said. But the Pittsburgh researcher cautioned that this could never be predicted with absolute certainty.

"Therefore, a large number of Americans dying in ICUs is almost certainly going to be a fact for a long time," Angus said.

"That means we need to make sure that ICUs are capable of providing appropriate, compassionate end-of-life care," Angus said. Doing so may be difficult, though, "unless there is a strong will at the public and policy levels to make sure ICU staff have the training and the time to provide good, or excellent, end-of-life care."

Dr. Mitchell M. Levy of Rhode Island Hospital and Brown University School of Medicine in Providence agrees that there is room for improvement in end-of-life care in the ICU.

"It is time to move our understanding of the barriers to quality end-of-life care 'from the bench to the bedside' and make our care for those dying in the ICU - something that is inevitable for almost 20 percent of Americans - more humane, compassionate and of the highest quality," Levy notes in an editorial that accompanies the study.

To gather the facts for their study, Angus and his colleagues examined deaths and hospital discharges in 1999 in Florida, Massachusetts, New Jersey, New York, Virginia and Washington.

About 38 percent of all deaths occurred in hospitals, Angus's team reports in the March issue of the journal Critical Care Medicine. And about 22 percent of all people who died were in an ICU or had recently received intensive care.

Among people who died, infants were most likely to receive intensive care near the end of life, while people older than age 85 were the least likely to receive intensive care.

The use of intensive care varied widely depending on a person's illness, according to the report. Patients with highly fatal conditions, such as cancer that had spread throughout the body, were less likely to receive intensive care near the end of life. In contrast, almost all people with an acute heart attack received intensive care.

It makes sense that people having a heart attack would be more likely to receive intensive care than people with end-stage cancer, since the odds of surviving a heart attack are much greater. But the fact that one third of people with end-stage cancer received intensive care shows how difficult it can be to predict when death will occur even when someone has a terminal illness, the researchers note.

SOURCE - Critical Care Medicine, March 2004.


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