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| Research article summary (published 30 Mar 2003): |
Dying in the intensive care unit: collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units.
Full Abstract
OBJECTIVE:
Describe modes of death and factors involved in decision-making together with life support limitation (LSL) procedures.
DESIGN:
Prospective, descriptive, longitudinal, and noninterventional study.
SETTING:
Sixteen pediatric intensive care units in Argentina.
PATIENTS:
Every patient who died during a 1-yr period was included.
MEASUREMENTS AND MAIN RESULTS:
Age, sex, length of stay (LOS), primary and admission diagnosis, underlying chronic disease (CD), postoperative condition (PO). Deaths were classified in four groups:
a) failed cardiopulmonary resuscitation (CPR); b) do-not-resuscitate (DNR) status; c) withholding or withdrawing life-sustaining treatment (WH/WD); and d) brain death (BD). Justifications were classified as a) imminent death; b) poor long-term prognosis; c) poor quality of life; and d) family request. Data were collected from medical records and interviews with the attending physicians. Descriptive statistics were performed. Differences among groups were analyzed through contingency tables and analysis of variance when required. Relative risks and confidence intervals of variables potentially related to LSL were analyzed, and logistic regression was performed. There were 6358 admissions and 457 deaths. CPR was performed in 52%, DNR in 16%, WH/WD in 20%, and BD in 11% of dead patients. BD patients were older, LOS and CD prevalence were higher in the WH/WD group. Inotropic drugs were the most frequently limited treatment in 110 patients (55%), CPR in 72 (35.6%), and mechanical ventilation in 63 (31%). Imminent death was the most frequently reported justification for LSL. CD and more staff were associated with a higher probability of LSL.
CONCLUSIONS:
Most of the patients in Argentina underwent CPR before their death. We have a high proportion of patients with CD (65%) and low BD diagnosis. PO condition decreased LSL probability in chronically ill patients. Do-not-resuscitate orders and withholding new treatments were the most common LSL. Active withdrawal was exceptional. The Ethics Committee was consulted in 5% of the LSL population.
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Author information
Author/s: Althabe, María (M); Cardigni, Gustavo (G); Vassallo, Juan C (JC); Allende, Daniel (D); Berrueta, Mabel (M); Codermatz, Marcela (M); Córdoba, Juan (J); Castellano, Silvia (S); Jabornisky, Roberto (R); Marrone, Yolanda (Y); Orsi, Maria C (MC); Rodriguez, Gabriela (G); Varón, Juan (J); Schnitzler, Eduardo (E); Tamusch, Héctor (H); Torres, José M (JM); Vega, Laura (L);
Affiliation: Hospital de Pediatría "J. P. Garrahan," Buenos Aires, Argentina.
Journal and publication information
Publication Type: Journal Article; Multicenter Study
Journal: Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies (Pediatr Crit Care Med), published in United States. (Language: eng)
Reference: 2003-Apr; vol 4 (issue 2) : pp 164-9
Dates: Created 2003/05/16; Completed 2003/07/29; Revised 2004/11/17;
PMID: 12749646, status: MEDLINE (last retrieval date: 11/6/2008)
Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.
Comments and Corrections
CommentIn: Pediatr Crit Care Med. 2003 Apr;4(2):257-8. (PMID: 12749665)
CommentIn: Pediatr Crit Care Med. 2003 Apr;4(2):259-60. (PMID: 12749666)
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