Going home to die from surgical intensive care units

Abstract

Purpose: To better understand events related to going home to die (GHTD) from the intensive care unit (ICU), with the hope that this information might improve the palliative care of ICU patients. Methods: This retrospective observational study was performed at a tertiary medical center-the National Taiwan University Hospital. All surgical ICU mortality cases between 1 January 2003 and 31 December 2007 were included in this study. Results: The rate of GHTD from the ICU declined annually, but has reached a plateau of around 25% in recent years. Multivariate logistic regression analysis found independently significant factors associated with GHTD, including older age (OR: 1.013; P = 0.001), married status (OR: 2.128; P < 0.001), lower educational level (OR: 1.799; P = 0.001), and lack of DNR consent (OR: 1.499; P = 0.006). When treatment intensity was compared on the date of death, GHTD patients in general received more treatments and diagnostic procedures than those who died in the ICU. Univariate analysis showed that GHTD patients received significantly more advanced antibiotics, more chest radiography, greater use of sedatives, greater use of analgesics, and more transfusions, but less FiO2 and mechanical circulatory support than patients who died in the ICU. Conclusion: GHTD from the ICU is a special phenomenon in the Chinese cultural area, representing a cultural tradition rather than a form of palliative care. © 2009 Springer-Verlag.