Martinot A, Lejeune C, Hue V, Fourier C, Beyaert C, Diependaele J F, Deschildre A, Leclerc F
Service de réanimation infantile, hôpital Calmette, Lille, France.
Arch Pediatr. 1995 Aug;2(8):735-41. doi: 10.1016/0929-693x(96)81242-5.
There are few data available from European pediatric intensive care units (PICU) regarding the modes of death and their causes.
Two hundred and fifty nine children, not including neonates, died in the PICU over a 7-year period (1987-1993). Data were obtained from a computerized data base and the retrospective review of medical records by two intensivists. Deaths were classified into three groups according to the terminal event: brain death (BD), unsuccessful resuscitation (UR), do-not-resuscitate order and limitation and/or withdrawal of therapy (LWT).
BD was the most common mode of death (38%); UR accounted for 34% and LWT for 28% of deaths. There was no significant annual variation in the proportion of BD, UR and LWT. Age and sex were similar in the three groups. The predominant organ system failure involved upon admission was the central nervous system (52%) in the LWT group, and the cardiovascular system (54%) in the UR group. Severe chronic disease (37%) and immunosuppression (19%) were more prevalent in the LWT group than in the BD group. Time from admission to death was longer in the LWT group (median = 119 hours) as compared to the UR group (10 hours) and the BD group (54 hours). Ten percent of the BD patients became organ transplant donors. Sixty-seven per cent of BD patients had medical contraindication for organ donation: parents did not accept organ donation in 61% of potential cases. Thirty deaths (12%) seemed to be avoidable; dehydration from acute infectious gastroenteritis (n = 7) was the most common cause of avoidable death.
The modes of death in our PICU were statistically not different from those seen in two of four North-American PICUs; LWT was less prevalent than in the two other PICUs, but the patient populations were very different (presence of neonates and many cardiovascular surgery patients). Assessment of the severity of illness at admission and of functional outcome in the survivors are mandatory in future studies.
欧洲儿科重症监护病房（PICU）关于死亡方式及其原因的数据很少。
在7年期间（1987 - 1993年），259名儿童（不包括新生儿）在PICU死亡。数据来自计算机数据库，并由两名重症监护医生对病历进行回顾性审查。根据终末事件，死亡分为三组：脑死亡（BD）、复苏失败（UR）、不进行心肺复苏医嘱以及限制和/或停止治疗（LWT）。
脑死亡是最常见的死亡方式（38%）；复苏失败占死亡病例的34%，限制和/或停止治疗占28%。脑死亡、复苏失败和限制和/或停止治疗的比例没有显著的年度变化。三组的年龄和性别相似。LWT组入院时主要涉及的器官系统衰竭是中枢神经系统（52%），UR组是心血管系统（54%）。与BD组相比，LWT组严重慢性病（37%）和免疫抑制（19%）更为普遍。LWT组从入院到死亡的时间比UR组（10小时）和BD组（54小时）更长（中位数 = 119小时）。10%的脑死亡患者成为器官移植供体。67%的脑死亡患者存在器官捐献的医学禁忌：在61%的潜在病例中，父母不接受器官捐献。30例死亡（12%）似乎是可以避免的；急性感染性肠胃炎导致的脱水（n = 7）是可避免死亡的最常见原因。
我们PICU的死亡方式在统计学上与北美四个PICU中的两个所见的死亡方式没有差异；限制和/或停止治疗的发生率低于另外两个PICU，但患者群体差异很大（存在新生儿和许多心血管手术患者）。在未来的研究中，必须对入院时疾病的严重程度和幸存者的功能结局进行评估。
