Buang Siti Nur Hanim, Loh Sin Wee, Mok Yee Hui, Lee Jan Hau, Chan Yoke Hwee
Pediatric Palliative Care Service, Department of Pediatric Subspecialities, KK Women's and Children's Hospital, Singapore, Singapore.
Children's Intensive Care Unit, Department of Pediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore.
Front Pediatr. 2022 Jun 10;10:907268. doi: 10.3389/fped.2022.907268. eCollection 2022.
Palliative care (PC) is an integral component of optimal critical care (CC) practice for pediatric patients facing life-threatening illness. PC acts as an additional resource for patients and families as they navigate through critical illness. Although PC encompasses end of life care, it is most effective when integrated early alongside disease-directed and curative therapies. PC primarily focuses on improving quality of life for patients and families by anticipating, preventing and treating suffering throughout the continuum of illness. This includes addressing symptom distress and facilitating communication. Effective communication is vital to elicit value-based goals of care, and to guide parents through patient-focused and potentially difficult decision-making process which includes advanced care planning. A multidisciplinary approach is most favorable when providing support to both patient and family, whether it is from the psychosocial, practical, emotional, spiritual or cultural aspects. PC also ensures coordination and continuity of care across different care settings. Support for family carries on after death with grief and bereavement support. This narrative review aims to appraise the current evidence of integration of PC into pediatric CC and its impact on patient- and family-centered outcomes. We will also summarize the impact of integration of good PC into pediatric CC, including effective communication with families, advanced care planning, withholding or withdrawal of life sustaining measures and bereavement support. Finally, we will provide a framework on how best to integrate PC in PICU. These findings will provide insights on how PC can improve the quality of care of a critically ill child.
姑息治疗（PC）是为面临危及生命疾病的儿科患者提供最佳重症监护（CC）实践的一个不可或缺的组成部分。当患者及其家人应对重症时，PC作为一种额外的资源为他们提供支持。尽管PC涵盖临终关怀，但在与针对疾病的治疗和治愈性疗法早期整合时最为有效。PC主要致力于通过在疾病的整个过程中预测、预防和治疗痛苦来提高患者及其家人的生活质量。这包括解决症状困扰和促进沟通。有效的沟通对于引出基于价值观的护理目标以及指导家长经历以患者为中心且可能艰难的决策过程（包括预先护理计划）至关重要。在为患者及其家人提供支持时，无论是从心理社会、实际、情感、精神还是文化方面，多学科方法都是最有利的。PC还确保不同护理环境之间护理的协调与连续性。在患者去世后，通过悲伤和丧亲之痛支持继续为家人提供支持。本叙述性综述旨在评估目前将PC整合到儿科CC中的证据及其对以患者和家庭为中心的结果的影响。我们还将总结将优质PC整合到儿科CC中的影响，包括与家人的有效沟通、预先护理计划、维持生命措施的撤除或停止以及丧亲之痛支持。最后，我们将提供一个关于如何在儿科重症监护病房（PICU）中最佳整合PC的框架。这些发现将为PC如何改善危重病童的护理质量提供见解。
