Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature.

Title

Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature.

Creator

Moore P; Kerridge I; Gillis J; Jacobe S; Isaacs D

Publisher

Journal Of Paediatrics And Child Health

Date

2008

Subject

Child; Humans; Intensive Care Units; New South Wales; Hospital Mortality; Hospitals; adolescent; Preschool; infant; retrospective studies; Withholding Treatment/statistics & numerical data; Terminal Care; Pediatric/statistics & numerical data; Medical Audit; Medical Futility; Physician's Practice Patterns/statistics & numerical data

Description

OBJECTIVES: To examine withdrawal and limitation of life-sustaining treatment (WLST) in an Australian paediatric intensive care unit (PICU) and to compare this experience with published data from other countries. DESIGN: Retrospective chart review and literature review. SOURCE OF DATA: Review of 12 months of patient records from a tertiary Australian children's teaching hospital. Medline search using relevant key words focusing on death and PICU. RESULTS: Twenty of 27 deaths (74%) followed either WLST (n = 16) or Do Not Resuscitate (DNR) orders (n = 4); five children failed cardiopulmonary resuscitation (CPR); and two children were brain-dead. Meetings between the medical team and family were documented for 15 of 16 children (93.8%) before treatment was withdrawn. The average time between withdrawal of life support and death was 13 min. A review of the English-language literature revealed that 18-65% occurring in PICUs worldwide follow WLST and/or institution of DNR orders. Rates were higher (30-65%) in North America and Europe than elsewhere. Most PICU deaths occurred within 3 days of admission. North American and British parents appear to be involved in decisions regarding withdrawal and limitation of treatment more often than parents in other countries. CONCLUSIONS: Withdrawal and limitation of life-sustaining treatment was more common in an Australian children's hospital ICU than has been reported from other countries. Details of discussion with parents, including the basis for any decision to WLST, were almost always documented in the patient's medical record.
2008-08

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

Pages

404-408

Issue

7

Volume

44

Citation

Moore P; Kerridge I; Gillis J; Jacobe S; Isaacs D, “Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature.,” Pediatric Palliative Care Library, accessed September 22, 2021, https://pedpalascnetlibrary.omeka.net/items/show/14160.

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