Key Points
Question
In the absence quality metrics for end-of-life care in pediatric cardiac intensive care units (CICUs), how do interdisciplinary staff perceive quality of dying and death (QODD)?
Findings
In this cross-sectional survey study of 713 medical professionals involved in 60 deaths in the CICU, the pediatric intensive care unit (PICU)–QODD instrument was a reliable and valid measure of QODD in CICUs, with overall positive perceptions of QODD yet negative perceptions of the 7 days prior. Lower PICU-QODD scores were reported by nursing or allied health staff, by less experienced staff, for patients with cardiac-surgical admissions and comorbidities, and for deaths following treatment limitation or misaligned with family wishes.
Meaning
These data could guide strategies to improve staff well-being and end-of-life experiences.
The goal of this article is to highlight the overlapping nature of symptoms of delirium and acquired brain injury (ABI) in children and similarities and differences in treatment, with a focus on literature supporting an adverse effect of antipsychotic medications on recovery from brain injury. An interdisciplinary approach to education regarding overlap between symptoms of delirium and ABI is important for pediatric intensive care settings, particularly at this time when standardized procedures for delirium screening and management are being increasingly employed. Development of treatment protocols specific to children with ABI that combine both nonpharmacologic and pharmacologic strategies will reduce the risk of reliance on treatment strategies that are less preferred and optimize care for this population.
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