Ryan C A, Byrne P, Kuhn S, Tyebkhan J
Neonatal Intensive Care Unit, University of Alberta Hospital, Edmonton, Canada.
J Pediatr. 1993 Oct;123(4):534-8. doi: 10.1016/s0022-3476(05)80946-1.
To compare and contrast the modes of death in a neonatal (NICU) and a pediatric (PICU) intensive care unit.
Retrospective analysis of patient records.
All newborn infants and children (< 17 years of age) who died in the NICU and PICU at the University of Alberta Hospitals, Edmonton, between Jan. 1, 1990, to Dec. 31, 1991.
The mortality rate in the PICU was 8.7% (73/839) compared with 5.6% (75/1333) in the NICU (p = 0.007). Withdrawal of therapy was the most common cause of death in both units and occurred more commonly in the NICU (NICU = 69% vs PICU = 34%; p = 0.01). There were significantly more deaths as a result of failed cardiopulmonary resuscitation (CPR) in the PICU than in the NICU (29% vs 13%; p = 0.046). Death after no-CPR orders occurred with equal frequency in both units (NICU 17%; PICU 15%). Brain death accounted for 22% (16/87) of PICU deaths; no infant in the NICU was declared brain dead (p < 0.05). When deaths resulting from brain death and failed CPR were excluded, there was no significant difference between the two units regarding withdrawal of therapy (NICU 80% vs PICU 69%) and no-CPR orders (NICU 20% vs PICU 30%).
This study confirms that both withdrawal of therapy and no-CPR orders are part of current clinical practice in both the NICU and PICU settings. The ethical foundations and implications of these practices need further elaboration.
比较和对比新生儿重症监护病房（NICU）和儿科重症监护病房（PICU）的死亡模式。
对患者记录进行回顾性分析。
1990年1月1日至1991年12月31日期间在埃德蒙顿的阿尔伯塔大学医院NICU和PICU死亡的所有新生儿和儿童（<17岁）。
PICU的死亡率为8.7%（73/839），而NICU为5.6%（75/1333）（p = 0.007）。在两个病房中，撤掉治疗都是最常见的死亡原因，且在NICU更常见（NICU = 69% vs PICU = 34%；p = 0.01）。PICU因心肺复苏（CPR）失败导致的死亡显著多于NICU（29% vs 13%；p = 0.046）。未下达CPR医嘱后的死亡在两个病房中发生频率相同（NICU 17%；PICU 15%）。脑死亡占PICU死亡的22%（16/87）；NICU中没有婴儿被宣布脑死亡（p < 0.05）。排除因脑死亡和CPR失败导致的死亡后，两个病房在撤掉治疗（NICU 80% vs PICU 69%）和未下达CPR医嘱（NICU 20% vs PICU 30%）方面没有显著差异。
本研究证实，撤掉治疗和未下达CPR医嘱都是NICU和PICU当前临床实践的一部分。这些做法的伦理基础和影响需要进一步阐述。
