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[Modes of dying of children in Intensive Care Units in Spain: MOMUCIP study]
1Sección de Pediatría Crítica, Cuidados Intermedios y Paliativos Pediátricos, Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España.
Insights
In Spanish Paediatric Intensive Care Units (PICUs), over half of child deaths result from limitation of therapeutic efforts (LET). These deaths are more common in children with prior hospital admissions or serious chronic/oncological conditions.
Area of Science:
- Pediatric Critical Care Medicine
- Palliative Care
- Medical Ethics
Background:
- Child mortality in Paediatric Intensive Care Units (PICUs) is a critical area of focus.
- Understanding the circumstances surrounding death is essential for improving end-of-life care.
- Limitation of therapeutic efforts (LET) represents a significant aspect of pediatric end-of-life decisions.
Purpose of the Study:
- To categorize the various causes of death among children in Spanish PICUs.
- To specifically analyze the characteristics of children who die following a decision for limitation of therapeutic efforts (LET).
Main Methods:
- A multicenter retrospective study was conducted.
- Hospital discharge reports of deceased patients from 8 Spanish PICUs (2011-2017) were reviewed.
- Data on demographics, diagnoses, and end-of-life decisions were analyzed.
Main Results:
- Out of 337 deaths, 50.7% occurred after a LET decision, 33.8% after failed cardiopulmonary resuscitation, and 15.4% due to brain death.
- Common admission diagnoses included cardiac (32.6%) and respiratory (22.6%) problems.
- LET was more frequent in children with prior admissions, chronic illnesses, disabilities, or cancer.
Conclusions:
- At least half of pediatric deaths in Spanish PICUs involve a LET decision.
- LET is more prevalent in vulnerable pediatric populations, including those with chronic or oncological diseases.
- Healthcare professionals must be prepared for shared decision-making with families to ensure optimal end-of-life care quality.
Objective:
To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic efforts (LET).
Method:
A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017.
Results:
A total of 337 deaths were recorded, of which 151 (50'7%) occurred after a decision of LET, while 114 (33'8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%). A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission. LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%).
Conclusions:
At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality.
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