A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment
Title
A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment
Creator
Zawistowski CA; DeVita MA
Identifier
Publisher
Pediatric Critical Care Medicine
Date
2004
Subject
Child; Female; Humans; Male; Intensive Care Units; Palliative Care; Euthanasia; Patient Participation; Time Factors; Pediatric; adolescent; Preschool; infant; retrospective studies; ICU Decision Making; Parents/psychology; Analgesics/administration & dosage; Hypnotics and Sedatives/administration & dosage; Passive; Neuromuscular Blockade
Description
OBJECTIVE: To examine physiologic and therapeutic changes following withdrawal of life-sustaining treatment in children. DESIGN: Retrospective chart review. SETTING: University-affiliated tertiary care pediatric hospital. PATIENTS: All patients who had life-sustaining treatment withdrawn over a 5-yr period. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: A total of 125 charts were examined to obtain 50 in which the terminal event preceding death was withdrawal of life-sustaining treatment. Data are expressed as median (1st, 3rd quartiles). Median hospital stay before death was 20 days (1st and 3rd quartiles, 8 and 30). Median time from decision to withdraw life-sustaining treatment to actual withdrawal was 30 mins (1st and 3rd quartiles, 10 and 180). All interventions were simultaneously discontinued in 80% of patients with mechanical ventilation followed by vasopressors being most common. No patients had stepwise reduction in ventilator rate before discontinuing the mechanical ventilation. Devices were rarely removed from patients including endotracheal tubes. Time from withdrawal of life-sustaining treatment to death was 15 mins (5, 30); only seven patients took >60 mins to die. Multivariable analysis (Kruskal-Wallis test) of various factors revealed simultaneous withdrawal of life-sustaining treatment, female gender, and not having received renal therapy as hastening death. CONCLUSIONS: Forgoing life-sustaining treatment in a small cohort of children at a single institution follows a pattern: Most cases occur after prolonged intensive care unit stays, withdrawal of treatment occurs almost immediately after the decision to withdraw, most treatments are withdrawn simultaneously rather than sequentially, and most patients die within minutes of life-sustaining treatment cessation. This is the first pediatric study to report the time to death after withdrawal of life-sustaining treatment and factors associated with shorter time to death in children.
2004
Rights
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
Journal Article
Citation List Month
Backlog
Citation
Zawistowski CA; DeVita MA, “A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment,” Pediatric Palliative Care Library, accessed February 18, 2025, https://pedpalascnetlibrary.omeka.net/items/show/12802.