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A review of children's dying in a paediatric intensive care unit
B Anderson1, E McCall, A Leversha
1Paediatric Intensive Care Unit, Children's Health South Pacific, Auckland.
Insights
Families actively participated in end-of-life decisions for children in the paediatric intensive care unit (PICU). While support services were valuable, follow-up care for bereaved families and staff needs improvement.
Area of Science:
- Pediatric Intensive Care
- Palliative Care
- Bereavement Support
Background:
- End-of-life care in pediatric intensive care units (PICUs) involves complex decisions.
- Understanding family and staff needs during a child's death is crucial.
Purpose of the Study:
- To identify methods for treatment withdrawal, staff support, and family follow-up for children dying in a PICU.
- To evaluate the effectiveness of existing support systems.
Main Methods:
- Retrospective review of 25 children who died in the PICU during 1992.
- Categorization into two groups: cessation of active treatment and continuation of active resuscitation.
Main Results:
- 16 children had treatment withdrawn, often involving artificial ventilation cessation, with family and specialist consultation.
- 9 children received continued resuscitation until death.
- Family presence at death was common; a Maori liaison group provided support to 18 families.
- Follow-up for bereaved families and staff support was inadequate.
Conclusions:
- Families are willing to participate in end-of-life decision-making for their children.
- Multidisciplinary, time-consuming, and difficult decisions characterize pediatric end-of-life care.
- Support services like Te Whanau Atawhai are beneficial across ethnic groups.
- Allowing parental presence during resuscitation may be considered.
- Deficiencies in follow-up necessitated the introduction of a grief education and support service.
Aim:
To identify methods of treatment withdrawal, staff support and follow up of families with children dying in a paediatric intensive care unit (PICU).
Method:
A retrospective review of the 25 children who died in the PICU over 1992 was made.
Results:
There were two groups of patients. Group A (16 children) had cessation of active treatment. The decision to cease treatment took a median time of 16 hours and was always made in consultation with other specialists and family. Cessation of artificial ventilation was the most common mechanism of treatment withdrawal. Supplemental morphine was administered to 8 children. Group B (9 children) had continuation of active resuscitation until death. The child's family was present at the time of death in both groups. Te Whanau Atawhai (a Maori liaison group) played an active support role to 18 families. Follow up of bereaved families and staff support was poor.
Conclusions:
Family members are willing to take an active part in the decision making process regarding management of the dying child. This process is multidisciplinary, time consuming and difficult. Valuable assistance for all ethnic groups was gained through the services of Te Whanau Atawhai. Consideration should be given to allowing parents to stay during acute resuscitation of a critically ill child. There were deficiencies of both parental and staff followups. As a consequence, we have introduced a grief education and support service through the, child and family psychiatric service for families and staff.