ABSTRACT
OBJECTIVES: To describe practical considerations and approaches to best practices for end-of-life care for critically ill children and families in the PICU. DATA SOURCES: Literature review, personal experience, and expert opinion. STUDY SELECTION: A sampling of the foundational and current evidence related to the withdrawal of life-sustaining therapies in the context of childhood critical illness and injury was accessed. DATA EXTRACTION: Moderated by the authors and supported by lived experience. DATA SYNTHESIS: Narrative review and experiential reflection. CONCLUSIONS: Consequences of childhood death in the PICU extend beyond the events of dying and death. In the context of withdrawal of life-sustaining therapies, achieving a quality death is impactful both in the immediate and in the longer term for family and for the team. An individualized approach to withdrawal of life-sustaining therapies that is informed by empiric and practical knowledge will ensure best care of the child and support the emotional well-being of child, family, and the team. Adherence to the principles of holistic and compassionate end-of-life care and an ongoing commitment to provide the best possible experience for withdrawal of life-sustaining therapies can achieve optimal end-of-life care in the most challenging of circumstances.