Withholding or withdrawing life-sustaining treatments: An 8-yr retrospective review in a Spanish pediatric intensive care unit

Launes, Cristian; Cambra, F.J.; Jordán, Iolanda; Palomeque, A.

doi:10.1097/pcc.0b013e31820aba5b

Cited by 31 publications

(30 citation statements)

References 8 publications

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“…This confirms a substantial burden of newly diagnosed neurologic injuries even in patients who die during the course of CICU admission. In contrast to previous studies in a general pediatric intensive care setting, we could not find an association between neurologic injury and foregoing life-sustaining treatment in our CICU (p = 0.23) (17,18).…”

Section: Discussioncontrasting

confidence: 85%

Modes of Death in a Pediatric Cardiac ICU*

Polito

Garisto

Pezzella

et al. 2016

Pediatric Critical Care Medicine

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Section: Discussioncontrasting

confidence: 85%

Modes of Death in a Pediatric Cardiac ICU*

Polito

Garisto

Pezzella

et al. 2016

Pediatric Critical Care Medicine

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“…According to literature, the religious background19 34 and the length of professional experience of clinicians may be important impact factors;9 14 however, in our research, no differences were found in attitude score among different religious beliefs and professional backgrounds. The reason for the differences between this research and previous literature may be that demographic data in these research participants presented a centralised tendency, such as a predominance of Buddhism or Taoism (table 1).…”

Section: Discussioncontrasting

confidence: 61%

“…This may be one reason that a previous study found that dying neonates received insufficient analgesic medicines in NICUs in Taiwan 4. To compare results with other studies conducted in Spain,19 USA,20 Italy, France, The Netherlands and Sweden,6 research participants were more likely to express concern regarding the use of analgesics in NICUs. This research result showed that there is an urgent need to change and improve the neonatal professionals' attitudes regarding pain control care for these terminally ill neonates in Taiwan.…”

Section: Discussionmentioning

confidence: 94%

The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan

et al. 2012

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The purposes of research were to describe the neonatal clinicians' personal views and attitudes on neonatal ethical decision-making, to identify factors that might affect these attitudes and to compare the attitudes between neonatal physicians and neonatal nurses in Taiwan. Research was a cross-sectional design and a questionnaire was used to reach different research purposes. A convenient sample was used to recruit 24 physicians and 80 neonatal nurses from four neonatal intensive care units in Taiwan. Most participants agreed with suggesting a do not resuscitate (DNR) order to parents for dying neonates (86.5%). However, the majority agreed with talking to patients about DNR orders is difficult (76.9%). Most participants agree that review by the clinical ethics committee is needed before the recommendation of 'DNR' to parents (94.23%) and nurses were significantly more likely than physicians to agree to this (p=0.043). During the end-of-life care, most clinicians accepted to continue current treatment without adding others (70%) and withholding of emergency treatments (75%); however, active euthanasia, the administration of drug to end-of-life, was not considered acceptable by both physicians and nurses in this research (96%). Based on our research results, providing continuing educational training and a formal consulting service in moral courage for neonatal clinicians are needed. In Taiwan, neonatal physicians and nurses hold similar values and attitudes towards end-of-life decisions for neonates. In order to improve the clinicians' communication skills with parents about DNR options and to change clinicians' attitudes for providing enough pain-relief medicine to dying neonates, providing continuing educational training and a formal consulting service in moral courage are needed.

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“…In developed countries, most pediatric deaths occur in intensive care settings (1–3). Severely ill children are admitted to pediatric intensive care units (PICUs) to receive potentially curative therapies.…”

Section: Introductionmentioning

confidence: 99%

End-of-Life Practices Among Tertiary Care PICUs in the United States

Meert

Keele

Morrison

et al. 2015

Pediatric Critical Care Medicine

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Objective To describe variability in end-of-life practices among tertiary care pediatric intensive care units (PICUs) in the U.S. Design Secondary analysis of data prospectively collected from a random sample of patients (n=10,078) admitted to PICUs affiliated with the Collaborative Pediatric Critical Care Research Network (CPCCRN) between December 4, 2011 and April 7, 2013. Setting Seven clinical centers affiliated with the CPCCRN Patients Patients included in the primary study were <18 years of age, admitted to a PICU, and not moribund on PICU admission. Patients included in the secondary analysis were those who died during their hospital stay. Interventions None. Measurements and Main Results Two hundred and seventy-five (2.7%, range across sites 1.3%–5.0%) patients died during their hospital stay; of these, 252 (92%, 76%–100%) died in a PICU. Discussions with families about limitation or withdrawal of support occurred during the initial PICU stay for 173 (63%, 47%–76%, p=0.27) patients who died. Of these, palliative care was consulted for 67 (39%, 12%–46%); pain service for 11 (6%, 10 of which were at a single site); and ethics committee for 6 (3%, from 3 sites). Mode of death was withdrawal of support for 141 (51%, 42%–59%), failed CPR for 53 (19%, 12%–28%), limitation of support for 46 (17%, 7%–24%), and brain death for 35 (13%, 8%–20%); mode of death did not differ across sites (p=0.58). Organ donation was requested from 101 (37%, 17%–88%, p<0.001) families. Of these, 20 (20%, 0%–64%) donated. Sixty-two (23%, 10%–53%, p<0.001) deaths were medical examiner cases. Of non-medical examiner cases (n=213), autopsy was requested for 79 (37%, 17%–75%, p<0.001). Of autopsies requested, 53 (67%, 50%–100%) were performed. Conclusions Most deaths in CPCCRN-affiliated PICUs occur after life support has been limited or withdrawn. Wide practice variation exists in requests for organ donation and autopsy.

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Withholding or withdrawing life-sustaining treatments: An 8-yr retrospective review in a Spanish pediatric intensive care unit

Cited by 31 publications

References 8 publications

Modes of Death in a Pediatric Cardiac ICU*

Modes of Death in a Pediatric Cardiac ICU*

The attitudes of neonatal professionals towards end-of-life decision-making for dying infants in Taiwan

End-of-Life Practices Among Tertiary Care PICUs in the United States

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