Decisões de terminalidade em Unidade de Terapia Intensiva antes e depois de treinamento em práticas de final de vida

Abstract

Most of the deaths in intensive care units (ICU) occur after limitation or withdrawal of life support treatments. It´s very important the application of good care practices in terminally ill patients at the intensive care unit for preventing dysthanasia, that is, prolonged and more suffering death. Objectives: To analyze end-of-life practices before and after a period of multiprofessional training. Material and Method: Quasi-experimental, observacional, prospective, cohort study with historical control. All patients admitted to an ICU over the age of 18 and who died between May 1st and August 31st, 2018 were included (Study Group). Patients who died betweem February 1st and July 31st, 2016, were part of Control Group. A training program for the multidisciplinary team in end-of-life practices was carried out between the two periods throughout the year 2017. Results: of the 180 patients who died in the period, 153 were the object of the study, included by withhold life-sustaining treatment (N=119), withdraw life-sustaining treatment (N=13), unsuccessful cardiopulmonary resuscitation (N=13), brain death (N=8). Patients were excluded due to death in less than 48 hours after hospitalization (N=26) and under 18 years old (N=1). The mean age of the patients was 60.6 ± 16.3 years old, the most of them were male (62.1%). In the Study group 86.2% of patients who died received some terminality decision compared to 72.2% the Control group (p=0.002). Withhold of life support measures occurred in 90.1% of patients and withdrawal of futile life support measures in 9.8%. The length of time between the discussion with the family and the terminality decision was one day [0-2 days]. Conclusion: end-of-life decisions were quite frequent after training program, but the withholding life-sustaining treatment still significantly overlaps withdrawing of useless measures.