Death and dying in the intensive care unit

Abstract

In the Netherlands most patients die in the intensive care unit (ICU) after a decision to withdraw life-sustaining measures (WOLSM) has been made. The ICU patients in whom life-sustaining measures are withdrawn are relatively old and are severely ill, according to the APACHE and SOFA scores.

The patient group with severe trauma to the central nervous system has the highest incidence of WOLSM. Although this seems logical, just because neurological outcome is so difficult to predict, early withdrawing introduces a substantial self-fulfilling prophecy, making reliable prognostication in the near future almost impossible. Especially in the young patient group, even in the case of severe neurological damage, patience is to be advised.