A Window of Opportunity for ICU End-of-Life Care— A Retrospective Cohort Study

Abstract

Abstract PURPOSE The 'window of opportunity' for ICU staff to deliver end-of-life (EOL) care lies in the timeframe from 'diagnosing the dying' to death. We aimed to describe the characteristics of trajectories for dying patients in Danish ICUs and to examine if physicians diagnose dying patients in time to perform EOL care and, if so, whether a window of opportunity for EOL care exists. METHODS From the Danish Intensive Care Database, we identified patients ≥18 years old admitted to a Danish ICU between January and December 2020 with an ICU stay of >96 h (four days) and who died during the ICU stay or within seven days after ICU discharge. A chart review was performed on 250 consecutive patients admitted from January 1, 2020 in an ICU in the Central Denmark Region. RESULTS Most patients (223 (89%)) were diagnosed as dying. Of those patients who received mechanical ventilation, 171 (68%) died after abrupt discontinuation of mechanical ventilation and 63 (25%) died after gradual withdrawal. Patients whose mechanical ventilation was discontinued abruptly died after a median of one hour (IQR: 0-15) and five hours (IQR: 2-15) after a diagnosis of dying was recorded. In contrast, patients with a gradual withdrawal died after a median of 108 hours (IQR: 71-189) and 22 hours (IQR: 5-67) after a diagnosis of dying was recorded. CONCLUSION EOL care hinges on the ability to diagnose the dying. This study shows that there is a short window of opportunity for EOL care, particularly for patients being weaned from mechanical ventilation.