Consensus conference Predicting outcome in ICU patients

Jury members:
P. Suter (Chairman), A. Armaganidis, F. Beaufils, X. Bonfill, H. Burchardi, D. Cook, A. Fagot-Largeault, L. Thijs, S. Vesconi, A. Williams

Scientic advisors: J.R. Le Gall, R. Chang

Introduction

The purpose of intensive care medicine is to diagnose and treat patients with acute life threatening illness, and to restore their previous health and quality of life. Care of the critically ill patients has become increasingly complex over the last two decades. Modern technologic advances now enable us to manage previously terminal conditions and patients can be kept alive for weeks or months, even when their prognosis is dismal. As reasonable hope of recovery fades, the health care team confronts another obligation: to help the dying achieve a peaceful and dignified death. The costs of intensive care include direct and indirect costs, opportunity costs and intangible costs such as human suffering. In addition to medical factors, individual and societal values, ethical, legal and economic issues increasingly affect the delivery of intensive care. An escalating proportion of health care money is spent on a small percentage of hospitalized patients in the ICU during their last few days of life. The appropriate allocation of limited resources available should be considered when decisions are made.

For more than a decade, intensive care physicians and clinical investigators have developed various scoring systems in an effort to make better use of collective clinical experience in the ICU, and to address questions of effectiveness, efficiency, equity and quality of intensive care. Although scoring systems have also been created to measure the intensity and effectiveness of therapeutic interventions, nursing needs, and patient and family satisfaction with ICU services provided, most attention has been focused on the development and use of illness severity scores. At present, three such scoring systems are in widespread use: APACHE, SAPS and MPM. Severity of illness is most often defined as the estinated probability of hospital mortality. Illness severity scores have been proposed for predicting outcome for critically ill patients, to improve resource allocation and to assist in clinical decision making.

In formulating this report, the jury of this Consensus Conference synthesized evidence published in the medical literature and data presented by the Conference speakers.