[Therapeutic effort adequacy directives. Experience of a Pediatric Palliative Care Unit]

Limitation of medical treatment (LOMT) directives are a relevant clinical-ethical procedure in the care of children with life-threatening conditions.

To describe the percentage and characteristics of patients with LOMT records, including recommendations, time to implementation, and adherence.

Retrospective study between 2009 and 2024, in children cared for by the Pediatric Palliative Care Unit of the Centro Hospitalario Pereira Rossell in Uruguay (UCPP-CH- PR). The variables evaluated were age, pathology, participants in decision-making, record, measures "to be performed" and "not to be performed", time between UCPP-CHPR referral/ LOMT decision and between LOMT/ death, place of death, and adherence to the LOMT directives.

LOMT were recorded in 18.2% (244/1341) of patients; the median age was 4.8 years and 66% had severe neurological impairment. Healthcare teams and caregivers participated in the decision-making process in 88% of cases. The record was performed in a specific form in 88.5% of the cases. The LOMT directives included "to be performed": analgesia and comfort care (100%), admission to the general pediatric ward (96%); and "not to be performed": cardiopulmonary resuscitation (96%), admission to intensive care (98%), and mechanical ventilation support (98%). 4 patients underwent compassionate extubating. The median time between UCPP-CHPR/ LOMT was 6 months. A total of 77.4% (189/244) of the patients died, 70% of them while admitted. The median time between LOMT/ death was 3 months. The adherence rate to LOMT directives was 98%.

Almost one-fifth of the children cared for by the UCPP-CHPR had LOMT directives. In most cases, healthcare professionals and caregivers participated in the decision-making process, and the directives were recorded in a specific form in the clinical history. In almost all deceased children, the LOMT directives were respected.