• Emilio Rodriguez-Ruiz, Maitane Campelo-Izquierdo, Montserrat Mansilla Rodríguez, Beatriz Elena Lence Massa, Ana Estany-Gestal, Andrés Blanco Hortas, Raquel Cruz-Guerrero, Cristobal Galbán Rodríguez, María Sol Rodríguez-Calvo, and Antonio Rodríguez-Núñez.
• Intensive Care Medicine Department, University Clinic Hospital of Santiago de Compostela (CHUS), Galician Public Health System (SERGAS), Santiago de Compostela, Spain; Health Research Institute of Santiago de Compostela (IDIS), Santiago de Compostela, Spain. Electronic address: r.ruizemilio@gmail.com.
• J Crit Care. 2021 Aug 1; 64: 131-138.

PurposeTo describe the way patients die in a Spanish ICU, and how the modes of death have changed in the last 10 years.Materials And MethodsRetrospective observational study evaluating all patients who died in a Spanish tertiary ICU over a 10-year period. Modes of death were classified as death despite maximal support (D-MS), brain death (BD), and death following life-sustaining treatment limitation (D-LSTL).ResultsAmongst 9264 ICU admissions, 1553 (16.8%) deaths were recorded. The ICU mortality rate declined (1.7%/year, 95% CI 1.4-2.0; p = 0.021) while ICU admissions increased (3.5%/year, 95% CI 3.3-3.7; p < 0.001). More than half of the patients (888, 57.2%) died D-MS, 389 (25.0%) died after a shared decision of D-LSTL and 276 (17.8%) died due to BD. Modes of death have changed significantly over the past decade. D-LSTL increased by 15.1%/year (95% CI 14.4-15.8; p < 0.001) and D-MS at the end-of-life decreased by 7.1%/year (95% CI 6.6-7.6; p < 0.001). The proportion of patients diagnosed with BD remained stable over time.ConclusionsEnd-of-life practices and modes of death in our ICU have steadily changed. The proportion of patients who died in ICU following limitation of life-prolonging therapies substantially increased, whereas death after maximal support occurred significantly less frequently.Copyright © 2021 Elsevier Inc. All rights reserved.

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