Cause of death in intensive care patients within 2 years of discharge from hospital.

OBJECTIVE: To identify intensive care patients dying within 2 years of discharge from hospital and assess whether the cause of death was related to the diagnosis at hospital discharge. DESIGN, SETTING AND PARTICIPANTS: A retrospective cohort study of all patients admitted to the intensive care unit at Wellington Hospital, New Zealand, between 1 July 2001 and 30 June 2003, using data from the ICU database. Mortality data were obtained from the New Zealand National Death Registry. MAIN OUTCOME MEASURES: Death within 2 years of hospital discharge; cause of death and its relation to the hospital discharge diagnosis. RESULTS: Of 1984 patients discharged home, 193 died within 2 years. One-year and 2-year survival rates were 93.8% and 90.3%, respectively. Two-year mortality rates were 4.6% in elective cardiac surgical patients, 19.7% in elective noncardiac surgical patients, 16.9% in acute patients admitted from the operating room, and 10.2% in other acute patients. Among the 193 patients who died after discharge, 124 deaths (64.2%) were related to the diagnosis at hospital discharge. The mortality rate in this group was highest at 3 months (90.5%) and lower at 6 months (75.0%), then averaged 51.4% after 6 months. Cause of death was related to discharge diagnosis in 46.2% of elective cardiac surgical patients, 66.6% of elective non-cardiac surgical patients, 60.5% of acute patients admitted from the operating room, and 75.4% of other acute patients. Cancer was the cause of death in 34.2% of elective cardiac surgical patients, 66.7% of elective non-cardiac surgical patients, 48.8% of acute patients admitted from the operating room, and 29.0% of other acute patients. CONCLUSION: Survival rates of ICU patients after discharge from hospital are high. Deaths are closely related to the discharge diagnosis only in the first 6 months after discharge. Cancer is a common cause of death. Elective non-cardiac surgical patients have the worst outcomes.

Intensive care in an unusual setting: management of pneumonia in a chimpanzee.

We report a case in which intensive care doctors and nurses became involved in the care of a young chimpanzee who required ventilation for pneumonia at Wellington Zoo, New Zealand. This required staff to work outside the usual protected environment of a hospital intensive care unit. The chimpanzee, Bahati, was ventilated for 3 days, replicating intensive care practice, but died. Logistical challenges included equipment procurement, environment, electrical safety, gas supply and infection control. Other difficulties included differences in physiology, nursing care and therapeutics. End-of-life processes were similar, with zoo staff responding as if they were immediate family. Euthanasia was an unfamiliar process to ICU staff. Bahati's death received national media attention and some criticism of the involvement of intensive care staff. The zoo staff were overwhelmed and grateful that everything possible was done for Bahati.