Background: Pediatric Advanced Life Support provides guidelines for resuscitating children in cardiopulmonary arrest. However, the role physicians' attitudes and beliefs play in decision-making when terminating resuscitation has not been fully investigated. This study aims to identify and explore the vital "non-medical" considerations surrounding the decision to terminate efforts by U.S.-based Pediatric Emergency Medicine (PEM) physicians.
Methods: A phenomenological qualitative study was conducted using PEM physician experiences in terminating resuscitation within a large freestanding children's hospital. Semi-structured interviews were conducted with 17 physicians, sampled purposively for their relevant content experience, and continued until the point of content saturation. Resulting data were coded using conventional content analysis by 2 coders; intercoder reliability was calculated as κ of 0.91. Coding disagreements were resolved through consultation with other authors.
Results: Coding yielded 5 broad categories of "non-medical" factors that influenced physicians' decision to terminate resuscitation: legal and financial, parent-related, patient-related, physician-related, and resuscitation. When relevant, each factor was assigned a directionality tag indicating whether the factor influenced physicians to terminate a resuscitation, prolong a resuscitation, or not consider resuscitation. Seventy-eight unique factors were identified, 49 of which were defined by the research team as notable due to the frequency of their mention or novelty of concept.
Conclusion: Physicians consider numerous "non-medical" factors when terminating pediatric resuscitative efforts. Factors are tied largely to individual beliefs, attitudes, and values, and likely contribute to variability in practice. An increased understanding of the uncertainty that exists around termination of resuscitation may help physicians in objective clinical decision-making in similar situations.
Download full-text PDF |
Source |
---|---|
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7071657 | PMC |
http://dx.doi.org/10.1186/s12245-020-0263-6 | DOI Listing |
Crit Care Resusc
December 2024
Department of Intensive Care, Austin Hospital, Heidelberg, Victoria, Australia.
Objective: To assess current evidence regarding guanfacine use in hospitalized patients with delirium.
Introduction: Delirium is a common and important complication of critical illness. Central alpha-2 agonists are often used for symptomatic management.
Crit Care Resusc
December 2024
Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, Australia.
Objective: Extracorporeal membrane oxygenation (ECMO) is a high-risk procedure with significant morbidity and mortality and there is an uncertain volume-outcome relationship, especially regarding long-term functional outcomes. The aim of this study was to examine the association between ECMO centre volume and long-term death and disability outcomes.
Design Setting And Participants: This is a registry-embedded observational cohort study.
Crit Care Resusc
December 2024
Department of Intensive Care, Austin Hospital, Melbourne, VIC, Australia.
Background: Severe intensive care unit-acquired hypernatraemia (ICU-AH) is a serious complication of critical illness. However, there is no detailed information on how this condition develops.
Objectives: The objective of this study was to study the prevalence, risk factors, trajectory, management, and outcome of severe ICU-AH (≥155 mmol·L).
Crit Care Resusc
December 2024
Australian and New Zealand Intensive Care - Research Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne Australia.
Objective: To describe the use of and outcomes from awake prone positioning (APP) in nonintubated patients with COVID-19 in Australian intensive care units (ICUs) in comparison to those who did not receive APP, and to explore the temporal relationship between publication of APP research and changes in clinical practice.
Design: Multicentre, observational cohort study.
Setting: Seventy-eight Australian ICUs participating in SPRINT-SARI Australia.
Crit Care Resusc
December 2024
Intensive Care Unit, Queen Elizabeth II Jubilee Hospital, Coopers Plains, QLD, Australia.
Objective: Knowledge of intensive care unit (ICU) acquired hypernatremia (ICU-AH) has been hampered by the absence of granular data and confounded by variable definitions and inclusion criteria.
Design: Multicentre retrospective cohort study.
Setting: Twelve ICUs in Queensland (QLD), Australia.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!