Preferred Language and Race Impact Code Status in Critically Ill Children.

Importance: Few studies have assessed the relationships between language, race, and code status in a PICU.

Objectives: We aimed to identify whether non-English language preference (NELP) or race was associated with code status in a PICU.

Design, Setting, And Participants: This was a single-center retrospective cohort study of 45,143 patients admitted to the PICU between January 2013 and December 2022, excluding those with pre-PICU do not resuscitate (DNR) orders.

Exploring Ethical Dimensions in Neuropalliative Care.

Neurologic illnesses can be challenging to diagnose, involve changes in consciousness, and are often complicated by prognostic uncertainty. These disorders can affect how individuals interact with their environment, and as a result, many ethical concerns may arise related to their medical care. Key ethical issues in neuropalliative care include shared decision-making, evolving autonomy and capacity, best interest and harm principles, beneficence and nonmaleficence, futile and inappropriate care, justice and equity, and ableism.

"Death as the One Great Certainty": ethical implications of children with irreversible cardiorespiratory failure and dependence on extracorporeal membrane oxygenation.

Introduction: Advances in medical technology have led to both clinical and philosophical challenges in defining death. Highly publicized cases have occurred when families or communities challenge a determination of death by the irreversible cessation of neurologic function (brain death). Parallels can be drawn in cases where an irreversible cessation of cardiopulmonary function exists, in which cases patients are supported by extracorporeal cardiopulmonary support, such as extracorporeal membrane oxygenation (ECMO).

Admission Functional Status is Associated With Intensivists Perception of Extracorporeal Membrane Oxygenation Candidacy for Pediatric Acute Respiratory Failure.

Objectives: To determine the association between admission Functional Status Scale (FSS) category and perceived extracorporeal membrane oxygenation (ECMO) candidacy for pediatric acute respiratory failure.

Design: Prospective, cross-sectional study.

Setting: Single-center, quaternary, and ECMO referral academic children's hospital between March 2021 and January 2022.

Ventilator Weaning and Terminal Extubation: Withdrawal of Life-Sustaining Therapy in Children. Secondary Analysis of the Death One Hour After Terminal Extubation Study.

Objective: Terminal extubation (TE) and terminal weaning (TW) during withdrawal of life-sustaining therapies (WLSTs) have been described and defined in adults. The recent Death One Hour After Terminal Extubation study aimed to validate a model developed to predict whether a child would die within 1 hour after discontinuation of mechanical ventilation for WLST. Although TW has not been described in children, pre-extubation weaning has been known to occur before WLST, though to what extent is unknown.

Harnessing the Humanities to Foster Staff Resilience: An Annual Arts and Humanities Rounds at a Children's Hospital.

Working in healthcare can be fulfilling, meaningful, and sometimes exhausting. Creative endeavors may be one way to foster personal resilience in healthcare providers. In this article, we describe an annual arts and humanities program, the Ludwig Rounds, developed at a large academic children's hospital.

Development of the perceived miscommunication measure in the pediatric intensive care unit.

Purpose: Miscommunication between parents and healthcare providers in the Pediatric Intensive Care Unit (PICU) can affect family-provider relationships and outcomes. This paper reports on the development and psychometric testing of a measure for parent perceived miscommunication, defined as the failure to communicate clearly as perceived by relevant stakeholders in the PICU.

Design And Methods: Miscommunication items were identified through a review of the literature with interdisciplinary experts.

Organ Donation From Patients on Extracorporeal Membrane Oxygenation at the Time of Death.

Unlabelled: To describe the clinical characteristics and organ donation rate of patients supported by extracorporeal membrane oxygenation (ECMO) at the time of death.

Design: Retrospective observational study. Pearson chi-square and Fisher exact tests were used in statistical analyses.

Pediatric Shared Decision-Making for Simple and Complex Decisions: Findings From a Delphi Panel.

Objective: To develop recommendations for pediatric shared decision-making (SDM).

Methods: We conducted a Delphi method study from 2020 to 2021 with an international panel (n = 21) of clinicians, researchers, and parents with expertise in pediatric SDM. We conducted semistructured interviews to identify the key processes of pediatric SDM.

A Taxonomy of Objections to Brain Death Determination.

Family objections to evaluating a patient for death by neurologic criteria, or "brain death," are challenging for the family and the medical team. In this article, we categorize brain death evaluation refusals into a taxonomy: informational objections, emotional objections, and principled objections. We offer suggested approaches for clinicians to respond to refusals on the basis of the category.

Pediatric brain death certification: a narrative review.

In the five decades since its inception, brain death has become an accepted medical and legal concept throughout most of the world. There was initial reluctance to apply brain death criteria to children as they are believed more likely to regain neurologic function following injury. In spite of early trepidation, criteria for pediatric brain death certification were first proposed in 1987 by a multidisciplinary committee comprised of experts in the medical and legal communities.

Parents as Advocates for Pediatric Palliative Care.

Caring for a child with a serious or life-limiting illness presents many challenges for families and health care providers. Through that experience (and, many times, as it ends), parents are compelled to find and make meaning from their ultimate loss and the many losses along the way. In this Advocacy Case Study, we describe the experiences that led a bereaved mother to seek to harness the insights from her own family's loss to help support other families facing the challenges and complexities of a child's serious illness.

Variability in Pediatric Brain Death Determination Protocols in the United States.

Objective: To determine the variability in pediatric death by neurologic criteria (DNC) protocols between US pediatric institutions and compared to the 2011 DNC guidelines.

Methods: In this cross-sectional study of DNC protocols obtained from pediatric institutions in the United States via regional organ procurement organizations, protocols were evaluated across 5 domains: general DNC procedures, prerequisites, neurologic examination, apnea testing, and ancillary testing. Descriptive statistics compared protocols to each other and the 2011 guidelines.

What Should We Do When Families Refuse Testing for Brain Death?

Two commentaries respond to a case about apnea testing to confirm death by neurologic criteria.