End-of-life care in a pediatric intensive care unit: the impact of the development of a palliative care unit.
BMC Palliat Care
; 19(1): 74, 2020 May 28.
Article
em En
| MEDLINE
| ID: mdl-32466785
ABSTRACT
BACKGROUND:
The purpose of this paper is to describe how end-of-life care is managed when life-support limitation is decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit.METHODS:
A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records.RESULTS:
One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding life-sustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn.CONCLUSIONS:
The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care.Palavras-chave
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Cuidados Paliativos
/
Assistência Terminal
/
Unidades de Terapia Intensiva Pediátrica
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article