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[Limitation of Vital Support in a Chilean Pediatric Intensive Care Unit: 2004-2014]

Bettina von Dessauer1, Carmen Benavente1, Emilia Monje1

  • 1Facultad de Medicina, Universidad de Chile, Chile.

Revista Chilena De Pediatria
|March 17, 2018
PubMed

Insights

Withholding or withdrawing life-sustaining treatment (LTSV) occurred in 1.5% of pediatric intensive care unit (PICU) admissions. This process, often involving severe neurologic damage, showed significant variability in patient care decisions.

Area of Science:

  • Pediatric Critical Care Medicine
  • Medical Ethics
  • Health Services Research

Background:

  • Withholding or withdrawing life-sustaining treatment (LTSV) is a complex ethical consideration in pediatric intensive care units (PICUs).
  • Understanding the frequency and characteristics of LTSV is crucial for improving end-of-life care and ethical decision-making.

Purpose of the Study:

  • To describe the frequency and characteristics of patients undergoing LTSV in a PICU between 2004 and 2014.
  • To analyze the diagnostic and pathophysiological factors associated with LTSV decisions.

Main Methods:

  • A retrospective, observational descriptive study was conducted using PICU patient tracking logs and quality indicator records.
  • Data included all PICU patients with an ethical dilemma involving proposed LTSV, including those rejected for ICU admission or who died in other units with LTSV.

Main Results:

  • LTSV was identified in 1.5% of 7821 PICU admissions (118 patients).
  • Common LTSV interventions included Non-Resuscitation Orders (ONR) for all, Non-Innovation Orders (ONI) in 78.8%, and withdrawal of therapeutics or mechanical ventilation in 14.4% and 6.8%, respectively.
  • Neurologic and oncologic diseases each accounted for 23.7% of diagnoses, with severe chronic neurologic damage being the predominant condition (39%) leading to LTSV.

Conclusions:

  • LTSV is a feasible process when integrated into daily clinical analysis and team involvement.
  • The variability observed in LTSV processes is expected due to the individualized nature of ethical decisions.
Abstract

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