Adequacy of Therapeutic Effort at the End of Life in Intensive Care Units: An Audit From Chile

Introduction: Adequacy of therapeutic effort (ATE), defined as providing treatments proportionate to the patient’s clinical condition and prognosis, is crucial in end-of-life care in intensive care units (ICUs). These decisions vary significantly across different countries, influenced by cultural, ethical, and religious contexts. In Chile, a predominantly Catholic country (42% Catholic, according to the latest census), end-of-life decision-making in ICUs presents cultural nuances. We aimed to characterize the patterns of mortality and evaluate the adequacy of therapeutic efforts in end-of-life scenarios among critically ill patients in Chile.


Methods: We conducted an audit reviewing clinical records of all patients who died in five ICUs from March 1 to June 30, 2025. Data collected included demographic information, clinical diagnosis, length of ICU stay, and explicit documentation regarding the adequacy of therapeutic effort provided. The clinical outcomes were analyzed to determine the nature and appropriateness of therapeutic interventions at the end of life.


Results: Fifty-two patient deaths were analyzed, evenly distributed by gender. Adequacy of therapeutic effort was documented explicitly in 45 patients (86.5%), whereas seven patients (13.5%) had no formal documentation of ATE assessment. Patients with explicit ATE documentation were older (mean age 72 vs. 52 years), though the difference was not statistically significant (p = 0.55). Most common conditions included neurological, pulmonary, and infectious diseases (19.2% each). Median ICU stay was 8 days, with early mortality ( < 24 hours) occurring in four cases, three with documented adequacy assessment. Prolonged ICU stays (>7 days) occurred in 20 patients, 90% of whom had documented ATE.


Conclusions: The study highlights a high rate of formal adequacy of therapeutic effort assessment among critically ill patients, particularly in older patients and those with prolonged ICU stays. Our findings emphasize the importance of structured approaches in assessing therapeutic proportionality and reinforce the influence of cultural and religious contexts on end-of-life care practices in Chile.