[A "good" death in pediatric ICU: is it possible?]

Area of Science:

• Pediatric critical care medicine
• Palliative care
• End-of-life care

Context:

• Pediatric intensive care units (PICUs) frequently encounter situations requiring withdrawal of life-sustaining treatment (LST).
• The role of palliative care is increasingly recognized in pediatric end-of-life decision-making.
• Intensivists require guidance for managing death with dignity in the PICU setting.

Purpose:

• To offer guidelines for intensivists on facilitating a humane and dignified death for pediatric patients.
• To apply palliative care principles to the complex PICU environment.
• To improve the end-of-life experience for children and their families.

Summary:

• Effective palliative care in the PICU involves open family communication and shared decision-making.
• Addressing family's religious and spiritual needs is crucial for a dignified death.
• Pain and symptom management, especially during LST withdrawal, is paramount.
• Allowing family presence during LST interruption and respecting their wishes enhances the process.

Impact:

• Implementation of these guidelines can lead to more humane and dignified deaths for children in the PICU.
• This approach contrasts with the often perceived impersonal nature of high-technology critical care environments.
• Improved end-of-life care can provide comfort and closure to grieving families.