Related Experiment Video
Updated: May 10, 2025
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Futile therapy protocols: A 3-year review of the implementation of Polish guidelines on ineffective organ function
Maria Damps1, Beata Rybojad2, Alicja Bartkowska-Śniatkowska3
1Department of Anesthesiology and Intensive Care, Upper Silesian Child Health Centre, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland. maria.damps@sum.edu.pl.
Insights
Futile therapy (FT) protocols in Polish pediatric intensive care units (PICUs) aided decision-making for end-of-life care. The study highlights the protocol
Area of Science:
- Pediatric Intensive Care Medicine
- Clinical Ethics
- Palliative Care Research
Background:
- Futile therapy (FT) presents complex ethical and clinical challenges in pediatric intensive care units (PICUs).
- Standardized protocols are crucial for guiding end-of-life decisions in critically ill children.
- Implementation of FT protocols requires careful evaluation of their impact on patient care and decision-making processes.
Purpose of the Study:
- To evaluate the implementation and impact of futile therapy (FT) protocols in Polish PICUs.
- To analyze the characteristics of patients undergoing FT protocols.
- To assess the role of FT protocols in facilitating end-of-life care decisions.
Main Methods:
- Retrospective analysis of 48 futile therapy protocols from three academic PICUs in southern Poland.
- Data collection by designated personnel at each participating hospital.
- Review of patient demographics, primary diagnoses, complications, and outcomes post-protocol implementation.
Main Results:
- The study included patients aged 1 month to 18 years, with neurological and oncological conditions being primary diagnoses.
- Common complications included severe birth asphyxia, chronic respiratory failure, and circulatory failure.
- Over one-third of patients were discharged, while a significant proportion died in the ward; median survival post-protocol was 42 days.
Conclusions:
- Implemented FT protocols facilitated decision-making regarding the discontinuation of futile therapy in Polish PICUs.
- The protocol was most frequently applied to infants and children under one year of age.
- The median survival time post-protocol implementation suggests a positive role for palliative care in managing end-of-life situations.
Background And Objectives:
This study aimed to evaluate the implementation and impact of futile therapy (FT) protocols in pediatric intensive care units (PICUs) in Poland.
Methods:
A retrospective analysis 48 futile therapy protocols signed at three academic pediatric intensive care units (PICUs) in southern Poland. A designated individual at each of the hospitals gathered detailed data from the protocols.
Results:
The children's ages ranged from 1 month to 18 years, the primary diagnoses were neurological conditions (n = 22, 45.83%), oncological conditions (n = 11, 22.92%), and prematurity (n = 9, 19.75%). The most common concomitant complications included severe birth asphyxia (n = 21, 43.75%), chronic respiratory failure (n = 18, 37.50%), circulatory failure (n = 10, 20.85%), and acute respiratory failure (n = 10, 20.85%). More than one-third of the patients were discharged (n = 17, 35.42%), while the remaining patients continued treatment in their primary wards (n = 31, 64.58%). Information on the 37 patients treated at these two centers shows that most (n = 25, 67.57%) died in the ward where they were hospitalized. The survival time after the protocol was signed ranged from 2 to 705 days, with a median of 42 days.
Conclusions:
The guidelines implemented in the study centers facilitated decision-making regarding the discontinuation of FT. The protocol was most frequently applied to newborns and children under 1 year of age. A median of survival time after implement FTP affirming the positive role of palliative care.
