Predicting Outcomes in the ICU

We appreciate how bewildering, and perhaps immobilizing, a situation with a highly uncertain outcome can be. You may feel helpless and unable to make any plans or contribute to decisions about treatment. Without at least some idea of the most likely outcome, you have no reference point on which to anchor your thought process or contribute to treatment decisions regarding the patient.

Fortunately, since in most cases the doctor can provide a likely prognosis, resorting to a prediction model for some guidance is not necessary.

However, sometimes you cannot obtain sufficient information to have even a minimal confidence level on which to base treatment decisions. This is when use of a prediction model is more appropriate.

It is important for you to know that you and your loved one have options. Just because an aggressive form of therapy such as a breathing machine or kidney machine has been started does not mean that it should be continued indefinitely. Likewise, aggressive forms of treatment such as cardiopulmonary resuscitation (CPR)or other life-sustaining procedures are not effective or appropriate under all situations. A patient (or the patient's agent) has the same right to refuse or withdraw these sorts of therapies as to request them.

When faced with critical questions such as these, it becomes very important to put your own feelings aside and to consider the wishes of the patient. An advance directive, such as a living will or durable power of attorney for health care, and previous conversations help us understand the wishes of a patient who is no longer able to effectively communicate. You should feel free to discuss these issues with your family, your clergy and the ICU team. Please make sure that the patient's wishes are clearly communicated to the doctor.