Sadly not all patients get better with intensive care, and some die in the unit. The staff deal with this on a regular basis and are extremely sympathetic to the families’ needs at this unhappy time.
Keeping the family updated on developments and decisions is vital to helping them through, and sometimes they will be called into the unit at short notice if the patient is getting worse quickly. The family should not be asked to bear the brunt of any decision-making but it is right that they understand what is happening and why. The ICU team work together to decide if the treatment that a patient is receiving, which maybe unpleasant or painful, is no longer of benefit to them, and will not cure them, or will leave them with an impoverished quality of life that would not be tolerable for the patient. The family are important advocates of the patient’s likely wishes at this time, as most patients are not able to take part in discussions about their own care due to sedation or illness. Some patients have advance directives which must be taken into consideration at this time.
How the patient is cared for at the end of life will depend on the individual circumstances. Paramount is the comfort of the patient, and then comes the needs of the family. The family will be told what is going to happen and what to expect, although it is often difficult to predict how long it will take for the patient to pass away. Good pain relief, and if necessary sedation, is ensured, the amount of technology around patient and interference by staff is usually reduced and the family allowed time and privacy with the patient. Staff will help with any religious matters where possible.
Most patients die as result of their heart stopping so blood no longer flows around the body to keep it working. A few patients who have had major damage to their brain die as a result of brainstem death. The brainstem is fundamental to life and is the part of the brain where consciousness and breathing are controlled. If the brainstem dies these functions are lost, the heart still beats due its own internal pacemaker, but there is no hope of any recovery. Brainstem death is diagnosed by a set of special tests that look for brainstem function. This process requires skill and detailed explanation to the family.
Click for more information on what happens after a death in ICU