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End-of-life practices in patients admitted to pediatric intensive care units in Brazil: A retrospective study
Roiter de Albernaz Furtado1, Cristian Tedesco Tonial1, Caroline Abud Drumond Costa2
1Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Faculdade de Medicina e Terapia Intensiva Pediátrica, Hospital São Lucas, Departamento de Pediatria, Porto Alegre, RS, Brazil.
Insights
Life support limitation (LSL) occurred in 45.3% of pediatric intensive care unit (PICU) deaths, with increased parental involvement and withdrawal of support. This trend shows a shift in end-of-life care practices.
Area of Science:
- Pediatric Intensive Care
- Medical Ethics
- End-of-Life Care
Background:
- Life support limitation (LSL) is a complex aspect of pediatric intensive care.
- Understanding the prevalence and delivery of LSL is crucial for improving end-of-life care.
- Parental participation in LSL decisions is an evolving area of ethical consideration.
Purpose of the Study:
- To determine the prevalence of life support limitation (LSL) in patients who died after at least 24 hours in a pediatric intensive care unit (PICU).
- To examine parent participation in LSL decisions.
- To describe the methods of LSL delivery in a Brazilian tertiary PICU.
Main Methods:
- Retrospective cohort study including patients aged 1 month to 18 years who died in a tertiary PICU.
- Exclusion criteria included brain death and death within 24 hours of admission.
- Data collected on LSL reports, do-not-resuscitate orders, life support withdrawal, and patient demographics.
Main Results:
- The prevalence of LSL reports was 45.3% among eligible patients.
- Half of patients with LSL reports had life support withdrawn.
- Patients with LSL reports were older, had longer PICU stays, and higher admission severity scores.
Conclusions:
- LSL is associated with older, more severely ill patients, and significant family participation.
- There has been a historical increase in LSL and withdrawal of life support.
- Parental involvement in end-of-life care decisions is increasingly prevalent in PICU settings.
Objective:
To determine the prevalence of life support limitation (LSL) in patients who died after at least 24h of a pediatric intensive care unit (PICU) stay, parent participation and to describe how this type of care is delivered.
Methods:
Retrospective cohort study in a tertiary PICU at a university hospital in Brazil. All patients aged 1 month to 18 years who died were eligible for inclusion. The exclusion criteria were those brain death and death within 24h of admission.
Results:
53 patients were included in the study. The prevalence of a LSL report was 45.3%. Out of 24 patients with a report of LSL on their medical records only 1 did not have a do-not-resuscitate order. Half of the patients with a report of LSL had life support withdrawn. The length of their PICU stay, age, presence of parents at the time of death, and severity on admission, calculated by the Pediatric Index of Mortality 2, were higher in patients with a report of LSL. Compared with other historical cohorts, there was a clear increase in the prevalence of LSL and, most importantly, a change in how limitations are carried out, with a high prevalence of parental participation and an increase in withdrawal of life support.
Conclusions:
LSLs were associated with older and more severely ill patients, with a high prevalence of family participation in this process. The historical comparison showed an increase in LSL and in the withdrawal of life support.
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