Withdrawal of ventilatory support outside the intensive care unit: guidance for practice

Title

Withdrawal of ventilatory support outside the intensive care unit: guidance for practice

Creator

Laddie J; Craig F; Brierley J; Kelly P; Bluebond-Langner M

Publisher

Archives Of Disease In Childhood

Date

2014

Subject

adolescent; Child; Female; Humans; infant; Male; retrospective studies; Intensive Care Units; Palliative Care; Practice Guidelines as Topic; Resuscitation Orders; Pediatric; Preschool; Newborn; Mechanical; Ventilators; Place of Death; Guildlines; Paediatric Intensive Care (PICU)

Description

OBJECTIVE: To review the work of one tertiary paediatric palliative care service in facilitating planned withdrawal of ventilatory support outside the intensive care setting, with the purpose of developing local guidance for practice. METHODS: Retrospective 10-year (2003-2012) case note review of intensive care patients whose parents elected to withdraw ventilation in another setting. Demographic and clinical data revealed common themes and specific incidents relevant to local guideline development. RESULTS: 18 children (aged 2 weeks to 16 years) were considered. Three died prior to transfer. Transfer locations included home (5), hospice (8) and other (2). Primary pathologies included malignant, neurological, renal and respiratory diseases. Collaborative working was evidenced in the review including multidisciplinary team meetings with the palliative care team prior to discharge. Planning included development of symptom management plans and emergency care plans in the event of longer than anticipated survival. Transfer of children and management of extubations demonstrated the benefits of planning and recognition that unexpected events occur despite detailed planning. We identified the need for local written guidance supporting healthcare professionals planning and undertaking extubation outside the intensive care setting, addressing the following phases: (i) introduction of withdrawal, (ii) preparation pretransfer, (iii) extubation, (iv) care postextubation and (v) care postdeath. CONCLUSIONS: Planned withdrawal of ventilatory support outside the intensive care setting is challenging and resource intensive. The development of local collaborations and guidance can enable parents of children dependent on intensive care to consider a preferred place of death for their child, which may be outside the intensive care unit.
2014-09

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

812-816

Issue

9

Volume

99

Citation

Laddie J; Craig F; Brierley J; Kelly P; Bluebond-Langner M, “Withdrawal of ventilatory support outside the intensive care unit: guidance for practice,” Pediatric Palliative Care Library, accessed December 8, 2021, https://pedpalascnetlibrary.omeka.net/items/show/14954.

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