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Physicians' attitudes when faced with life-threatening events in children with severe neurological disabilities
Benjy Wosinski1, Christopher J Newman2
1a Paediatrics department , Lausanne University Hospital , Lausanne , Switzerland.
Insights
Physicians often avoid aggressive interventions like CPR for children with severe neurological disabilities. Experience influences decisions, highlighting the need for standardized care protocols in pediatric critical situations.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Medical ethics
Background:
- Children with severe neurological disabilities face heightened risks of life-threatening events.
- Physician decision-making in these critical scenarios requires careful consideration.
Purpose of the Study:
- To assess physicians' attitudes regarding life-sustaining treatment decisions for critically ill children with severe disabilities.
- To explore factors influencing these decisions.
Main Methods:
- A survey was conducted among physicians in Swiss pediatric intensive care, neurology, and rehabilitation units.
- Participants responded to scenarios involving a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I.
Main Results:
- A consensus favored comfort care and non-invasive ventilation, opposing tracheostomy and invasive ventilation.
- A majority of physicians opposed cardiopulmonary resuscitation (CPR) for both PIMD (61%) and SMA (51%) scenarios.
- More experienced physicians (over 20 years) were significantly more opposed to CPR than less experienced ones.
Conclusions:
- Physician attitudes toward end-of-life care for critically ill children are influenced by personal factors.
- Standardizing multidisciplinary approaches is crucial for consistent and ethical decision-making in complex pediatric cases.
Purpose:
Children with severe neurological disabilities are at an increased risk of acute, life-threatening events. We assessed physicians' attitudes when making decisions in these situations.
Methods:
We surveyed physicians in pediatric intensive care, neurology, and rehabilitation units in Swiss hospitals. The questionnaire explored participants' attitudes toward life-threatening situations in two scenarios: a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I.
Results:
The participation rate was 55% (52/95). There was a consensus favoring non-invasive ventilation and comfort care as well as avoiding tracheostomy and invasive ventilation. For the child with PIMD, 61% of participants opposed cardiopulmonary resuscitation (CPR), 51% for the child with SMA. Physicians with over 20 years of experience were significantly more opposed to providing CPR than less experienced colleagues.
Conclusions:
Physicians held different views, influenced by personal factors. This highlights the importance of standardizing multidisciplinary processes toward approaching these complex situations.