Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question was
You can check out last week’s question by clicking on the link here.
How Many Patients Die in Intensive Care (ICU)?
Mortality rates in the ICU (Intensive Care Unit) strongly depend on the severity of illness and the patient population analyzed. Admissions in the ICU vary in different countries. More than 5 million patients are admitted annually in United States, while there were 230,800 adult ICU admissions in Canada, an estimate of between 10,000 and 15,000 critically ill adult patients require critical care in ICUs each year in Ireland, ICU admissions each year in the United Kingdom of 271,079 with 160,000 patients admitted to Intensive Care Units (ICUs) in Australia and New Zealand and Germany, with 1.9 million ICU admissions annually.
The average mortality rate reported in the United States ranges from 8-19% or 500,000 deaths annually. Acute care separations that ended in death accounted only for 10% in Australia and New Zealand. ICU deaths occurring in Canada comprise 29.2% for one fiscal year, while there was an estimated 16,424 ICU mortality for the United Kingdom for the most recent year 2015 – 16. Please see table below:
| NHS Digital – Hospital Adult Critical Care Activity – 2015-16 Report
Breakdown of critical care unit discharge status1
|Critical care unit discharge status||Number of critical care records||Percentage of critical care records||Number of critical care records||Percentage of critical care records|
|Fully ready for discharge||100,863||57.1%||103,243||55.9%|
|Delayed discharge due to shortage of other ward beds||41,548||23.5%||46,146||25.0%|
|Patient died (no organs donated)||15,205||8.6%||15,606||8.5%|
|Current level of care continuing in another location||9,513||5.4%||9,842||5.3%|
|More specialised care in another location||3,962||2.2%||4,303||2.3%|
|Early discharge due to shortage of critical care beds||3,257||1.8%||2,929||1.6%|
|Discharge for palliative care||941||0.5%||983||0.5%|
|Self discharge against medical advice||507||0.3%||705||0.4%|
|Patient died (heart beating solid organ donor)||438||0.2%||426||0.2%|
|Patient died (cadaveric tissue donor)||290||0.2%||259||0.1%|
|Patient died (non heart beating solid organ donor)||115||0.1%||133||0.1%|
|Unknown / not recorded||83,052||32.0%||86,504||31.9%|
One research study from Canada, hospital beds and adult ICU beds per 100,000 population internationally showed an overall unadjusted ICU mortality of 9% in Canada. Internationally, there is wide variation in mortality rates, from 6% in Germany and 10% in the U.S., to 29% in the U.K.
There are different types of ICUs that provide care to specific patient populations categorized as:
WHAT ARE THE REASONS FOR ADMISSION TO THE ICU?
- intensive or invasive monitoring
- support of airway, breathing or circulation
- stabilization of acute or life-threatening medical problems
- comprehensive management of injury and/or illness
- restoration to stable health status or comfort while dying within an interdisciplinary and collaborative environment.
The Intensive Care Unit (ICU) is the part of the hospital where care is provided to the sickest patients. It is typified by having a high level of monitoring and therapeutic technologies, a very high degree of organization and high staff to patient ratios.
Despite the high severity of illness of patients admitted to ICU, most improve to the point to be discharged to a normal ward care environment. A significant proportion of these ICU-discharged patients subsequently die in the hospital with post-ICU mortality rates ranging from 6 to 27% [1–7] either as a result of residual organ dysfunction/failure or due to the inability of the staff in lower levels of care to cope appropriately with the needs of these patients.
Although patients in intensive care units (ICUs) receive care for a large variety of disease states, the leading causes of death in the ICU are:
Cardiovascular system failure is commonly faced by the intensivist. Heart failure can occur due to a host of predisposing cardiac disorders or as secondary effects of systemic illness. When the heart is unable to provide an adequate cardiac output to maintain adequate tissue perfusion, cardiogenic shock ensues. Without prompt diagnosis and appropriate management, these patients have significant morbidity and mortality, with in-hospital mortality approaching 60% for all age groups.
WHAT IS A CARDIOGENIC SHOCK?
Cardiogenic shock is a condition in which your heart suddenly can’t pump enough blood to meet your body’s needs. The condition is most often caused by a severe heart attack, but not everyone who has a heart attack has cardiogenic shock.
Cardiogenic shock is rare, but it’s often fatal if not treated immediately. If treated immediately, about half the people who develop the condition survive.
CARDIOGENIC SHOCK SIGNS AND SYMPTOMS:
- Rapid breathing
- Severe shortness of breath
- Sudden, rapid heartbeat (tachycardia)
- Loss of consciousness
- Weak pulse
- Low blood pressure (hypotension)
- Pale skin
- Cold hands or feet
- Urinating less than normal or not at all
SYMPTOMS OF A HEART ATTACK
Because cardiogenic shock usually occurs in people who are having a severe heart attack, it’s important to know the signs and symptoms of a heart attack. These include:
- Pressure, fullness or a squeezing pain in the center of your chest that lasts for more than a few minutes
- Pain extending to your shoulder, one or both arms, back, or even to your teeth and jaw
- Increasing episodes of chest pain
- Shortness of breath
- Lightheadedness or sudden dizziness
- Nausea and vomiting
MULTIPLE ORGAN DYSFUNCTION SYNDROME
Multiple organ dysfunction syndrome (MODS) is a continuum, with incremental degrees of physiologic derangements in individual organs; it is a process rather than a single event. Alteration in organ function can vary widely from a mild degree of organ dysfunction to completely irreversible organ failure. The degree of organ dysfunction has a major clinical impact.
In a classic 1975 editorial by Baue, the concept of “multiple, progressive or sequential systems failure” was formulated as the basis of a new clinical syndrome. Several different terms were proposed thereafter (eg, multiple organ failure, multiple system organ failure, and multiple organ system failure) to describe this evolving clinical syndrome of otherwise unexplained progressive physiologic failure of several interdependent organ systems.
Eventually, the term MODS was proposed as a more appropriate description. MODS is defined as a clinical syndrome characterized by the development of progressive and potentially reversible physiologic dysfunction in 2 or more organs or organ systems that is induced by a variety of acute insults, including sepsis.
CENTRAL NERVOUS SYSTEM FAILURE
Central nervous system (CNS) failure represents a spectrum of disease ranging from mild neurological impairment that may have motor, sensory, visual, speech, cognitive manifestations, or a combination thereof, to comatose states and brain death.
COMMON CAUSES OF CENTRAL NERVOUS SYSTEM FAILURE
- Spontaneous Intracerebral Hemorrhage
- Metabolic / Infectious Derangements: liver failure, renal failure, Diabetic Ketoacidosis (DKA), meningitis.
A sudden (acute) nervous system problem can cause many different symptoms, depending on the area of the nervous system involved. Stroke and transient ischemic attack (TIA) are common examples of acute problems. You may experience the sudden onset of one or more symptoms, such as:
- Numbness, tingling, weakness, or inability to move a part or all of one side of the body (paralysis).
- Dimness, blurring, double vision, or loss of vision in one or both eyes.
- Loss of speech, trouble talking, or trouble understanding speech.
- Sudden, severe headache.
- Dizziness, unsteadiness, or the inability to stand or walk, especially if other symptoms are present.
- Confusion or a change in level of consciousness or behavior.
- Severe nausea or vomiting
The outcomes after being admitted in the ICU are very difficult to predict and most ICU doctors know patients among all the thousands who did RECOVER, against all the odds. The ICU team is there to save lives and by all means, prolong life. In reality, yes, odds are in a Patients favor according to the statistics, there are massive numbers of ICU patients who survived and let your loved one be part of the overwhelming majority of ICU patients who made it through. Allowing death in the ICU – even when there is still uncertainty about the outcome for the patient can be straightforward but you can be powerful advocates for keeping your loved one ALIVE even when doctors think otherwise! Take into account what the patient themselves would have wanted and that is, valuing the chance of life at any cost!
How can you become the best advocate for your critically ill loved one, make informed decisions, get peace of mind, control, power and influence quickly, whilst your loved one is critically ill in Intensive Care?
You get to that all important feeling of making informed decisions, get PEACE OF MIND, CONTROL, POWER AND INFLUENCE when you download your FREE “INSTANT IMPACT” report NOW by entering your email below!
In Your FREE “INSTANT IMPACT” report you’ll learn quickly how to make informed decisions, get PEACE OF MIND, real power and real control and how you can influence decision making fast, whilst your loved one is critically ill in Intensive Care! Your FREE “INSTANT IMPACT” Report gives you in-depth insight that you must know whilst your loved one is critically ill or is even dying in Intensive Care!
Sign up and download your FREE “INSTANT IMPACT” REPORT now by entering your email below! In your FREE “INSTANT IMPACT” REPORT you’ll learn how to speak the “secret” Intensive Care language so that the doctors and the nurses know straight away that you are an insider and that you know and understand what’s really happening in Intensive Care! In your FREE report you’ll also discover
- How to ask the doctors and the nurses the right questions
- Discover the many competing interests in Intensive Care and how your critically ill loved one’s treatment may depend on those competing interests
- How to eliminate fear, frustration, stress, struggle and vulnerability even if your loved one is dying
- 5 mind blowing tips & strategies helping you to get on the right path to making informed decisions, get PEACE OF MIND, control, power and influence in your situation
- You’ll get real world examples that you can easily adapt to your and your critically ill loved one’s situation
- How to stop being intimidated by the Intensive Care team and how you will be seen as equals
- You’ll get crucial ‘behind the scenes’ insight so that you know and understand what is really happening in Intensive Care
- How you need to manage doctors and nurses in Intensive Care (it’s not what you think)
Thank you for tuning into this week’s YOUR QUESTIONS ANSWERED episode and I’ll see you again in another update next week!
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This is Patrik Hutzel from INTENSIVECAREHOTLINE.COM and I’ll see you again next week with another update!
- What Causes Organ Failure?
- Causes and Characteristics of Death in Intensive Care Units: A Prospective Multicenter Study
- Multiple Organ Dysfunction Syndrome in Sepsis
- Organ failure: central nervous system
- Nervous System Problems
- Cardiogenic shock
- Hospital Admitted Patient Care Activity, 2017-18
- NATIONAL ADULT CRITICAL CARE CAPACITY AND ACTIVITY CENSUS 2016, HSE Acute Hospitals Division, Critical Care Programme.
- Intensive Care Registries in Australia & New Zealand
- Variation in critical care services across North America and Western Europe*
- Philip R. Lee Institute for Health Policy Studies, ICU Outcomes
- The Location of Death and Dying Across Canada: A Study Illustrating the Socio-Political Context of Death and Dying
https://www.mdpi.com › pdf
- Case Mix Programme Summary Statistics 2015-2016
- Intensive Care Registries in Australia & New Zealand
- Hospital Adult Critical Care Activity 2015-16, Table 10: Breakdown of critical care unit discharge status 1
- The 10 COMMANDMENTS for PEACE OF MIND, control, power and influence if your loved one is critically ill in Intensive Care
- What could be the cause if my critically ill loved one is removed from an induced coma but still hasn’t woken up?
- My 80 year old father is in Intensive Care with Myeloma! The Intensive Care team HAS ASKED ME TO SIGN A “DNR” AND I REFUSED! What are MY OPTIONS?
- The 3 most dangerous mistakes that you are making but you are unaware of, if your loved one is a critically ill Patient in Intensive Care
- The 5 questions you need to ask when the Intensive Care team is talking about “Futility of treatment”, “Withdrawal of life support” or about “Withdrawal of treatment”
- HOW TO STOP BEING HELD HOSTAGE BY THE INTENSIVE CARE TEAM if your loved one is critically ill in Intensive Care!
- 5 POWERFUL THINGS YOU NEED TO DO IF THE INTENSIVE CARE TEAM IS NEGATIVE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My Mum has been diagnosed with STOMACH CANCER and is in ICU ventilated. CAN I TAKE HER HOME on a ventilator?
- The questions you need to ask the most senior doctor in Intensive Care, if your loved one is critically ill in Intensive Care
- How long does it take for my critically ill loved one to be taken off the ventilator and have their breathing tube/ endotracheal tube removed
- Why you must make up your own mind about your critically ill loved one’s situation in Intensive Care even if you’re not a doctor or a nurse!
- The ELEPHANT IN THE ROOM or HOW THE INTENSIVE CARE TEAM IS MAKING DECISIONS whilst your loved one is critically ill in Intensive Care!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO?
- 5 ways you are UNCONSCIOUSLY SABOTAGING yourself whilst your loved one is CRITICALLY ILL in Intensive Care and HOW TO STOP doing it!
- How to make sure that “what you see is always what you get” whilst your loved one is critically ill in Intensive Care
- 5 Ways to have control, power and influence while your loved one is critically ill in Intensive Care
- Family overjoyed as top court rules doctors must seek consent before taking a patient off life support
- How to make sure that your values and beliefs are known whilst your loved one is critically ill in Intensive Care
- My loved one has HIV, lymphoma on his brain, seizures, septic and is ventilated! The Intensive Care team is trying to TAKE MY HOPE AWAY and they are all NEGATIVE! HELP!
- MY PARTNER IS IN INTENSIVE CARE AFTER A BLEED ON A BRAIN! WE ARE WORRIED THAT THE INTENSIVE CARE TEAM WANTS TO SWITCH OFF THE VENTILATOR! HELP!
- HOW TO DEAL WITH A DIFFICULT INTENSIVE CARE TEAM, WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- What the doctors and the nurses behaviour in Intensive Care is telling you about the culture in a unit
- How to take control if your loved one has a severe brain injury and is critically ill in Intensive Care
- How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 1)
- How can I be prepared, be mentally strong and be well positioned for a Family meeting with the Intensive Care team?(PART 2)
- The four DEADLY SINS that Families of critically ill Patients in Intensive Care CONSTANTLY MAKE, but they are UNAWARE OF!
- My HUSBAND had a HORRIBLE work accident and went into CARDIAC ARREST! Will he be PERMANENTLY DISABLED
- Why decision making in Intensive Care GOES WAY BEYOND your critically ill loved one’s DIAGNOSIS AND PROGNOSIS!
- The 4 ways you can overcome INSURMOUNTABLE OBSTACLES whilst your loved one is critically ill in Intensive Care!
- How to get PEACE OF MIND, more control, more power and influence if your critically ill loved one is DYING in Intensive Care!
- The 5 QUESTIONS you need to ask, if the Intensive Care team wants you to DONATE your loved one’s ORGANS in an END OF LIFE SITUATION!
- MY PARTNER IS IN INTENSIVE CARE ON A VENTILATOR! THE INTENSIVE CARE TEAM WANTS TO DO A TRACHEOSTOMY AND I WANT TO HAVE HIM EXTUBATED! WHAT DO I DO? (PART 1)
- How MEDICAL RESEARCH DOMINATES your critically ill loved one’s diagnosis and prognosis, as well as the CARE and TREATMENT your loved one IS RECEIVING or NOT RECEIVING
- WHAT WOULD YOU DO if you knew that you COULD NOT FAIL, whilst your loved one is critically ill in Intensive Care
- How the Intensive Care team is SKILFULLY PLAYING WITH YOUR EMOTIONS, if your loved one is critically ill in Intensive Care!
- My father is in Intensive Care ventilated with LIVER FAILURE and KIDNEY FAILURE, I DON’T THINK HE WILL SURVIVE! HELP
- HOW TO GIVE YOURSELF PERMISSION TO HAVE PEACE OF MIND, CONTROL, POWER AND INFLUENCE WHEN YOUR LOVED ONE IS CRITICALLY ILL IN INTENSIVE CARE!
- My father has been weaned off the ventilator in Intensive Care and still has the Tracheostomy in. When can the Tracheostomy be removed?