Life-Sustaining Treatment Status at the Time of Death in a Japanese Pediatric Intensive Care Unit

Life-Sustaining Treatment Status at the Time of Death in a Japanese Pediatric Intensive Care Unit

Suzuki F;Takeuchi M;Tachibana K;Isaka K;Inata Y;Kinouchi K

American Journal of Hospice & Palliative Medicine

2018

decision making;Intensive Care Units;Life Support Care;Terminal Care sn [Statistics & Numerical Data];Adolescent;Artificial;Brain Death di [Diagnosis];Child;Female;Humans;Length of Stay;Life Support Care;Male;Pediatric sn [Statistics & Numerical Data];Preschool;Respiration;Resuscitation Orders;Retrospective Studies;Terminal Care px [Psychology];Time Factors;Withholding Treatment

BACKGROUND: Substantial variability exists among countries regarding the modes of death in pediatric intensive care units (PICUs). However, there is limited information on end-of-life care in Japanese PICUs. Thus, this study aimed to elucidate the characteristics of end-of-life care practice for children in a Japanese PICU. METHODS: We examined life-sustaining treatment (LST) status at the time of death based on medical chart reviews from 2010 to 2014. All deaths were classified into 3 groups: limitation of LST (limitation group, death after withholding or withdrawal of LST or a do not attempt resuscitation order), no limitation of LST (no-limitation group, death following failed resuscitation attempts), or brain death (brain death group). RESULTS: Of the 62 patients who died, 44 (71%) had limitation of LST, 18 (29%) had no limitation of LST, and none had brain death. In the limitation group, the length of PICU stay was longer than that in the no-limitation group (13.5 vs 2.5 days; P = .01). The median time to death after the decision to limit LST was 2 days (interquartile range: 1-5.5 days), and 94% of the patients were on mechanical ventilation at the time of death in the limitation group. CONCLUSIONS: Although limiting LST was a common practice in end-of-life care in a Japanese PICU, a severe limitation of LST such as withdrawal from the ventilator was hardly practiced, and a considerable LST was still provided at the time of death.

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November 2018 List