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We considered observational data available from the MIMIC-III open-access ICUdatabase and collected within a study period between year 2002 up to 2011. If apatient had multiple admissions to the ICU during the 30 days before death,only the first stay was analyzed, leading to a final set of 6,436 unique ICUadmissions during the study period. We tested two hypotheses: (i)administration of invasive intervention during the ICU stay immediatelypreceding end-of-life would decrease over the study time period and (ii)time-to-death from ICU admission would also decrease, due to the decrease ininvasive intervention administration. To investigate the latter hypothesis, weperformed a subgroups analysis by considering patients with lowest and highestseverity. To do so, we stratified the patients based on their SAPS I scores,and we considered patients within the first and the third tertiles of thescore. We then assessed differences in trends within these groups between years2002-05 vs. 2008-11.  Comparing the period 2002-2005 vs. 2008-2011, we found a reduction inendotracheal ventilation among patients who died within 30 days of ICUadmission (120.8 vs. 68.5 hours for the lowest severity patients, p<0.001; 47.7vs. 46.0 hours for the highest severity patients, p=0.004). This is explainedin part by an increase in the use of non-invasive ventilation. Comparing theperiod 2002-2005 vs. 2008-2011, we found a reduction in the use of vasopressorsand inotropes among patients with the lowest severity who died within 30 daysof ICU admission (41.8 vs. 36.2 hours, p<0.001) but not among those with thehighest severity. Despite a reduction in the use of invasive interventions, wedid not find a reduction in the time to death between 2002-2005 vs. 2008-2011(7.8 days vs. 8.2 days for the lowest severity patients, p=0.32; 2.1 days vs.2.0 days for the highest severity patients, p=0.74).

Withholding or withdrawing invasive interventions may not accelerate time to death among dying ICU patients