AI Article Synopsis
- The study analyzed end-of-life practices in pediatric intensive care units (PICUs) across the U.S., focusing on patients who died during their hospital stay.
- Out of 10,078 patients studied, 275 (2.7%) died, with most dying within the PICU and with significant discussions regarding limiting or withdrawing life support held with families.
- Findings revealed variability in practices like organ donation requests and autopsy rates, yet showed consistent modes of death across different sites, emphasizing a need for standardized end-of-life care approaches.
Article Abstract
Objective: To describe variability in end-of-life practices among tertiary care PICUs in the United States.
Design: Secondary analysis of data prospectively collected from a random sample of patients (n = 10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network between December 4, 2011, and April 7, 2013.
Setting: Seven clinical centers affiliated with the Collaborative Pediatric Critical Care Research Network.
Patients: Patients included in the primary study were less than 18 years old, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay.
Interventions: None.
Measurements And Main Results: Two hundred and seventy-five (2.7%; range across sites, 1.3-5.0%) patients died during their hospital stay; of these, 252 (92%; 76-100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 patients (63%; 47-76%; p = 0.27) who died. Of these, palliative care was consulted for 67 (39%; 12-46%); pain service for 11 (6%; 10 of which were at a single site); and ethics committee for six (3%, from three sites). Mode of death was withdrawal of support for 141 (51%; 42-59%), failed cardiopulmonary resuscitation for 53 (19%; 12-28%), limitation of support for 46 (17%; 7-24%), and brain death for 35 (13%; 8-20%); mode of death did not differ across sites (p = 0.58). Organ donation was requested from 101 families (37%; 17-88%; p < 0.001). Of these, 20 donated (20%; 0-64%). Sixty-two deaths (23%; 10-53%; p < 0.001) were medical examiner cases. Of nonmedical examiner cases (n = 213), autopsy was requested for 79 (37%; 17-75%; p < 0.001). Of autopsies requested, 53 (67%; 50-100%) were performed.
Conclusions: Most deaths in Collaborative Pediatric Critical Care Research Network-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.
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Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4562059 | PMC |
| http://dx.doi.org/10.1097/PCC.0000000000000520 | DOI Listing |
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