End-of-life care in a pediatric intensive care unit: The impact of the development of a palliative care unit

Title

End-of-life care in a pediatric intensive care unit: The impact of the development of a palliative care unit

Creator

Bobillo-Perez S; Segura S; Girona-Alarcon M; Felipe A; Balaguer M; Hernandez-Platero L; Sole-Ribalta A; Guitart C; Jordan I; Cambra F J

Publisher

BMC Palliative Care

Date

2020

Subject

palliative care; pediatric intensive care unit; hospital mortality; withholding treatment; withdrawal

Description

Background: The purpose of this paper is to describe how end-of-life care is managed when life-support limitation is decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit. Method(s): A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records. Result(s): One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding life-sustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn. Conclusion(s): The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care. Copyright © 2020 The Author(s).

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).

Citation List Month

August 2020 List

Collection

Citation

Bobillo-Perez S; Segura S; Girona-Alarcon M; Felipe A; Balaguer M; Hernandez-Platero L; Sole-Ribalta A; Guitart C; Jordan I; Cambra F J, “End-of-life care in a pediatric intensive care unit: The impact of the development of a palliative care unit,” Pediatric Palliative Care Library, accessed September 23, 2021, https://pedpalascnetlibrary.omeka.net/items/show/17161.

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