Uma "boa" morte em UTI pediátrica: é isso possível?

Abstract

Objective: In the modern pediatric intensive care unit (PICU) physicians are often faced with the need to interrupt life-sustaining treatment (LST) and to allow children to die when no further treatment options are available. Consequently, the importance of palliative care has been increasing in this context. The goal of this review is to provide intensivists with guidelines to allow PICU patients to have a more dignified and humane death. Sources of data:Medline was searched using relevant key-words, emphasizing the topic of death in the PICU. The principles of palliative care medicine were then applied to this context. Summary of the findings:To ensure a dignified death for a child receiving palliative care in the PICU some important measures must be taken, such as: let the family participate in the decision-making process in an open and honest manner; allow family members to perform their religious rites and rituals; offer them moments of complete privacy; effectively manage pain and discomfort, especially at the time of removal of LST; and finally, let the family be present when LST is interrupted, if they so desire.Conclusions: A child's death following withdrawal of LST in the PICU can be humane and dignified if basic principles of palliative care are followed. This is especially important in an environment that is notorious for the use of complex technology and described by the general public as inhumane.J Pediatr (Rio J) 2003;79(Suppl 2):S243-S54: Death, brain death, parents, palliative care, end-of-life care.

Limitação de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil

“…The presence of chronic diseases was significantly associated with LSL decisions, quite probably because these infants have a sufficiently well-known disease, with a poor prognosis, and prolonging their lives would sometimes result in useless treatments and unnecessary suffering. 4,6 On the other hand, the deaths that occurred in the first 24 hours of admission had received CPR more frequently, presumably because those were patients who had been admitted to the units without any established diagnosis, which resulted in high hopes for reversibility and had a yet unknown prognosis. 6 Of the revised medical charts that included death after LSL, 30% did not contain the description or filing of a planned sequence of events.…”

“…Conversely, in northern hemisphere countries, promoting a good death is a priority, and the presence of family at the time of death is quite common. 4,29,30 In this regard, Brazilian and South American pediatric intensive care should be improved and modified in the short run, so as to make end-of-life decisions a priority in medical education in our setting. 30,31 This study, just like most retrospective studies on death, has some limitations.…”

“…2,3 End-of-life decisions are now widely discussed, placing a high value on the respect for the patient, including a growing concern with maintaining dignity at the end of life and humanization of death. 4 Concomitantly, the concept of life support limitation (LSL), which includes do-notresuscitate orders, and withholding and withdrawal of life support, has appeared in medical practice to avoid the use of treatments that only prolong life but do not improve patient outcome, usually leading to useless treatments and needless suffering. 5 Currently, 90% of deaths occurring at adult ICUs in North America are preceded by some type of limitation of supportive care.…”

Práticas baseadas em evidências publicadas no Brasil: identificação e análise de suas vertentes e abordagens metodológicas

“…In the childhood and adolescence specialty, for example, EBP ranged from anxiety disorder, whether for treatment (18) or assessment (19) , vaccination (24)(25) , safety during nebulization (28) , ICU death (29) , physical exercise measure (33) , nutritional interventions and child growth (70) , prenatal and weight at birth (71) , among others. Another quite diversified example comes from psychiatry/mental health: medication treatments (15,18,20,76,80,89) , physical exercise (16) , cognitive therapy (17) , anxiety assessment instrument (19) , quality of life and food disorders (35) , psychological stress x hypertension (40) , family intervention in schizophrenia (50) etc.…”

Cuidados paliativos: desafios para cuidadores e profissionais de saúde

“…Tal resultado é contrariado por Garros (2003) É certo que a literatura sobre a temática do assistente social nos CP ainda é insipiente. Entretanto, a importância da atuação desse profissional é contemplada na definição da OMS sobre CP, quando ressalta a necessidade de se fazer uma intervenção no âmbito físico, psicológico, social e espiritual, exigindo-se para isso uma equipe multiprofissional que compreenda todos esses aspectos (SANTOS; PAGLIUCA; FERNANDES, 2007;PESSINI, 2005).…”