Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Pediatr Crit Care Med. 2011 Nov;12(6):e383-5. doi: 10.1097/PCC.0b013e31820aba5b.
To determine the death rate of patients who died in our pediatric intensive care unit after a decision to withhold or withdraw life-sustaining treatment was made and to describe the epidemiologic data, clinical (acute and chronic) conditions, end-of-life care, and decision-making processes corresponding to these patients.
Long-term retrospective review of patients' charts.
Mixed university-affiliated pediatric intensive care unit.
Patients younger than 18 yrs old whose deaths occurred after life-sustaining treatment was withheld or withdrawn.
None.
Epidemiologic and clinical data, the treatments received, the decision-making process, and the end-of-life pathway were evaluated. Ninety-seven of 311 deaths occurred after a medical decision to withhold life-sustaining treatment. Among these patients, the most common reason for admission was respiratory failure (44 of 97), followed by cardiopulmonary arrest and sepsis. In 50 of 97 there was a previously known neurologic condition before admission, 11 of 97 had a neoplasm or hematologic malignancy, 10 of 97 had a congenital heart disease, and 8 of 97 had a neuromuscular disease. The most common action for forgoing life-sustaining treatment was withdrawal of treatment (chiefly respiratory support). The median time for deciding to withhold or withdraw life-sustaining treatment was on day 3 of admission. A total of 85 of 97 deaths occurred within 48 hrs after the decision was made and action taken. The decision to forgo life-sustaining treatment was proposed by the family in 14 of 97 patients, and there was an explicit agreement between the medical staff and the patient's family in 88 of 97. In all cases, palliative analgesic/sedative treatment effectively maintained the child's comfort.
Withholding or withdrawing life-sustaining treatment was a frequent mode of death in our pediatric intensive care unit, occurring at a rate that falls in the midrange of literature values. The level of the parents' involvement with the team in the decision-making process, which was documented in 88 of 97 of the medical charts, was very high. Patients with chronic neurologic diseases or with severe cognitive sequelae constituted the main group in which the decision to forgo life-sustaining treatment was made.
确定在做出停止或撤回生命支持治疗的决定后，我院儿科重症监护病房（PICU）死亡患者的死亡率，并描述相应患者的流行病学数据、临床（急性和慢性）状况、临终关怀和决策过程。
对患者病历的长期回顾性分析。
混合大学附属儿科重症监护病房。
年龄小于 18 岁，停止或撤回生命支持治疗后死亡的患者。
无。
评估了流行病学和临床数据、所接受的治疗、决策过程和临终途径。311 例死亡中有 97 例是在做出停止生命支持治疗的医疗决定后发生的。在这些患者中，最常见的入院原因是呼吸衰竭（97 例中有 44 例），其次是心肺骤停和败血症。在 97 例中有 50 例在入院前有已知的神经疾病，11 例有肿瘤或血液恶性肿瘤，10 例有先天性心脏病，8 例有神经肌肉疾病。停止生命支持治疗最常见的行动是停止治疗（主要是呼吸支持）。决定停止或撤回生命支持治疗的中位时间是入院第 3 天。做出决定并采取行动后，97 例死亡中有 85 例在 48 小时内发生。停止生命支持治疗的决定是由家属提出的，在 97 例中有 14 例是医护人员和患者家属明确达成一致的。在所有情况下，姑息性镇痛/镇静治疗都有效地维持了患儿的舒适度。
停止或撤回生命支持治疗是我院儿科重症监护病房死亡的常见模式，其发生率处于文献值的中等范围。在 97 份病历中有 88 份记录了父母在决策过程中与团队的高度参与程度。决定停止生命支持治疗的主要人群是患有慢性神经疾病或有严重认知后遗症的患者。
