[Interdisciplinary ethics consultation on the surgical intensive care unit]

Abstract

Background: An interdisciplinary ethics consultation (EC) on the intensive care unit (ICU) can be requested by the clinical team as a result of a subjective assessment of the patient's situation. The aim of this study was to objectify the initiation of EC by means of the SOFA score and to examine its impact on the clinical course.

Patients and methods: Over a two-year period, all patients receiving an EC on the ICU were recorded. Age, hospital stay and mortality were compared with ICU patients who did not receive EC. SOFA score values of EC patients at the time of admission to the ICU and the time of EC were compared. Furthermore, the effect of different EC decisions (maximisation/limitation of treatment) on hospital stay and mortality were defined.

Results: EC was carried out in 52 of a total of 764 patients (6.8 %). Age (76.6 years; range: 40-99), hospital stay (20.5 days; range: 5-286) and ICU mortality (92.3 %) were significantly higher in EC patients compared to patients without EC (68.3 years; range: 10-100; p <or= 0.001) (3 days; range: 2-106; p <or= 0.001) (7.6 %; p <or= 0.001). The mean SOFA score at the time of EC (7.52; +/- 0.48 SEM) was significantly higher compared with that at the time of admission to the ICU (4.29; +/- 0.42 SEM) (p <or= 0.001). Following maximisation of treatment (n = 9), median hospital stay was significantly longer (13 days; range: 4-254) compared to other EC decisions (n = 43) (p <or= 0.007).

Conclusions: In critically ill patients, the interdisciplinary EC provides a meaningful tool for decision making between maximisation and reduction of treatment - facilitating improved end-of-life care and dignified dying. The indication for EC at the bedside should be supported by the SOFA score.