Introduction

Patients admitted to critical care units share a common characteristic: without invasive organ support and monitoring they will die. The majority recover; some die quickly even with treatment; a third group are supported while their prognosis remains unclear. They continue to receive treatment until either they improve or until it becomes apparent that they are not going to survive. At some point, we all confront the question, ‘Is it appropriate to continue aggressive support in the face of increasing futility of treatment?’

The aim of this chapter is to describe the process of dying in this environment and how to deal with the challenges presented. It does not explore the decision-making processes and ethical conundrums of identifying and dealing with patients who are dying in the intensive care unit.

Epidemiology

A greater number of people die in hospital rather than at home. Of all patients dying in hospital, 10% die in critical care units. Mortality rates are about 20% to 30% in critical care units admitting general adult patients. Up to 70% of those patients who die have treatment withheld or withdrawn. However, there is large variation in the proportion of patients for whom treatment is withheld or withdrawn and in the way patients are managed during the dying process. Up to 70% of families describe patients suffering pain and discomfort in the days before death.