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Text
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URL Address
<a href="http://doi.org/10.1097/00003246-200008000-00064" target="_blank" rel="noreferrer">http://doi.org/10.1097/00003246-200008000-00064</a>
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Title
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End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment
Publisher
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Critical Care Medicine
Date
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2000
Subject
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Humans; Intensive Care Units; Attitude of Health Personnel; Prospective Studies; Life Support Care; Job Satisfaction; Pediatric; infant; ICU Decision Making; Analgesics/administration & dosage; Hypnotics and Sedatives/administration & dosage; Terminal Care/methods; Ventilator Weaning
Creator
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Burns JP; Mitchell C; Outwater KM; Geller M; Griffith JL; Todres ID; Truog RD
Description
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OBJECTIVE: To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment is withdrawn. STUDY DESIGN: Prospective case series of 53 consecutive patients who died after the withdrawal of life-sustaining treatment in the pediatric intensive care unit at three teaching hospitals in Boston. Data on the reasons why medications were given were obtained from a self-administered anonymous questionnaire completed by the critical care physician and nurse for each case. Data on what medications were given were obtained from a review of the medical record. RESULTS: Sedatives and/or analgesics were administered to 47 (89%) patients who died after the withdrawal of life-sustaining treatment. Patients who were comatose were less likely to receive these medications. Physicians and nurses cited treatment of pain, anxiety, and air hunger as the most common reasons, and hastening death as the least common reason, for administration of these medications. Hastening death was viewed as an "acceptable, unintended side effect" of terminal care by 91% of physician-nurse matched pairs. The mean dose of sedatives and analgesics administered nearly doubled as life-support was withdrawn, and the degree of escalation in dose did not correlate with clinician's views on hastening death. CONCLUSION: Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death is seen as an unintended consequence of appropriate care. A large majority of physicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.
2000
Identifier
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<a href="http://doi.org/10.1097/00003246-200008000-00064" target="_blank" rel="noreferrer">10.1097/00003246-200008000-00064</a>
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Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Type
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Journal Article
2000
Analgesics/administration & dosage
Attitude Of Health Personnel
Backlog
Burns JP
Critical Care Medicine
Geller M
Griffith JL
Humans
Hypnotics and Sedatives/administration & dosage
ICU Decision Making
Infant
Intensive Care Units
Job Satisfaction
Journal Article
Life Support Care
Mitchell C
Outwater KM
Pediatric
Prospective Studies
Terminal Care/methods
Todres ID
Truog RD
Ventilator Weaning