Withholding aggressive treatments may not accelerate time to death among dying ICU patients

by   Daniele Ramazzotti, et al.

Critically ill patients may die despite aggressive treatment. In this study, we examine trends in the application of two such treatments over a decade, as well as the impact of these trends on survival durations in patients who die within a month of ICU admission. We considered observational data available from the MIMIC-III open-access ICU database, collected from June 2001 to October 2012: These data comprise almost 60,000 hospital admissions for a total of 38,645 unique adults. We explored two hypotheses: (i) administration of aggressive treatment during the ICU stay immediately preceding end-of-life would decrease over the study time period and (ii) time-to-death from ICU admission would also decrease due to the decrease in aggressive treatment administration. Tests for significant trends were performed and a p-value threshold of 0.05 was used to assess statistical significance. We found that aggressive treatments in this population were employed with decreasing frequency over the study period duration, and also that reducing aggressive treatments for such patients may not result in shorter times to death. The latter finding has implications for end of life discussions that involve the possible use or non-use of such treatments in those patients with very poor prognosis.


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