Madni Arshia, Matheson Jocelyn, Linz Amanda, Dalgo Austin, Siddique Rumana, Merlocco Anthony
University of Tennessee Health Sciences Center, Memphis, TN, USA.
Division of Hospice and Palliative Medicine, LeBonheur Children's Hospital, Memphis, TN, USA.
Pediatr Cardiol. 2024 Oct 22. doi: 10.1007/s00246-024-03681-9.
Evidence suggests that pediatric palliative care involvement (PPC) is beneficial to medically complex patients. Historically, PPC involvement has been overlooked or delayed and varies by institution but PPC awareness has increased in cardiovascular ICUs (CVICU) and so we investigated frequency and timeliness of PPC referral for patients dying in ICU. Retrospective study of pediatric cardiac patients experiencing death in ICU to review PPC presence and timing of initial PPC, most recent PPC, and interventions, therapies, CPR, and presence of do-not-resuscitate DNR discussion. Fifty-four patients died during a 5-year period aged 11d-17y (54% male). PPC involvement occurred in 40/54 (74%). Of those patients without PPC, the Center to Advance Palliative Care (CAPC) guidelines would have supported PPC in 11/14 (79%). DNR discussion was more likely in PPC patients (63% vs 14%; p = 0.0011), though often only on DOD. Comparing prior to DOD, PPC patients were still more likely to have DNR discussion (55% vs 0%; p = 0.0003). PPC patients were no less likely to have CPR on DOD (28% vs 43%, p = 0.29). PPC occurred frequently in patients experiencing death in CVICU. However, frequently the initial PPC occurred within a week or day of death. Patients without PPC would often qualify under published guidelines. Standardization, timing, and patient identification for PPC will expand efficacy in CVICU.
有证据表明，儿科姑息治疗介入（PPC）对病情复杂的患者有益。从历史上看，PPC介入一直被忽视或延迟，且因机构而异，但心血管重症监护病房（CVICU）对PPC的认知有所提高，因此我们调查了在ICU死亡患者的PPC转诊频率和及时性。对在ICU死亡的儿科心脏病患者进行回顾性研究，以审查PPC的存在情况、首次PPC的时间、最近一次PPC、干预措施、治疗方法、心肺复苏（CPR）以及不进行心肺复苏（DNR）讨论的情况。54名患者在5年期间死亡，年龄为11天至17岁（54%为男性）。40/54（74%）的患者接受了PPC介入。在那些未接受PPC的患者中，推进姑息治疗中心（CAPC）的指南会支持11/14（79%）的患者接受PPC。PPC患者更有可能进行DNR讨论（63%对14%；p = 0.0011），不过通常只在死亡当日进行。比较死亡当日之前的情况，PPC患者仍然更有可能进行DNR讨论（55%对0%；p = 0.0003）。PPC患者在死亡当日接受CPR的可能性并不低（28%对43%，p = 0.29）。PPC在CVICU死亡患者中频繁出现。然而，最初的PPC往往在死亡前一周或一天内才出现。未接受PPC的患者通常符合已发布的指南标准。PPC的标准化、介入时机和患者识别将扩大其在CVICU中的疗效。
