Perfil das condutas médicas que antecedem ao óbito de crianças em um hospital terciário

Abstract

Objective: To study the profile of care provided to pediatric patients suffering fatal outcomes at a university hospital, including: description of models, comparisons between units, associated factors, participants involved and records of decisions made.Methods: Cross-sectional study. One of the investigators reviewed the medical and nursing records of deceased patients. Interviews were held and questionnaires filled out with the care team members over a period of 12 months (May 1, 2002 to April 30, 2003. Results:The study included 106 cases. The most frequent treatment patterns at the hospital were: withholding advanced life support (51.9%) and unsuccessful cardiopulmonary resuscitation (44.3%). The decision to make a do-not-resuscitate order occurred later in the intensive care unit (p < 0.05). The restricted care category was more prevalent in the neonatal unit and among patients with chronic diseases that limit survival (p < 0.05). The professionals that most often participated in the decision-making process were the unit s treating physician and resident (52.8%) and the medical team (31.1%). Parents or guardians were observed to have been involved in 20.8% of cases. For the entire hospital, seven cases (6.6%) of ambiguous or discordant cardiopulmonary resuscitation procedures were found.Conclusions: Procedures involving limitation of therapy are frequent, especially in the neonatal unit. Diagnosis of brain death and withdrawal of advanced life support are, nevertheless, rare. Decisions to grant do-not-resuscitate orders are generally mate late, especially in the intensive care unit. In this sample procedures for full participation in decisions and for recording decisions were imperfect. J Pediatr (Rio J)

Cuidados paliativos em pediatria: uma revisão

“…Outra explicação plausível seria a comunicação inadequada com a família/paciente 26 . 29,30 . No entanto, Himelstein 5 ressalta que a qualidade do cuidado em pediatria está relacionada ao compartilhamento das decisões médicas entre a família, a criança e a equipe, o que permitiria esperar percentuais significativamente mais elevados.…”

Cuidados no final da vida em pediatria: muito mais que uma luta contra a entropia

“…However, significant progress in this area has been observed in Brazil, considering that in 1998 the prevalence of LSL in one of the PICUs included in the Lago et al 1 study was only 6%. 5 Some of the data in the studies of Lago et al 1 and Tonelli et al 2 are a matter of concern. Only 3.2% of patients studied by Lago et al 1 and none of those studied by Tonelli et al 2 died after withdrawal of life support, with strong preference being given to the more passive limitation of support, despite it being widely accepted that no significant ethical differences exist between the two.…”

“…5 Some of the data in the studies of Lago et al 1 and Tonelli et al 2 are a matter of concern. Only 3.2% of patients studied by Lago et al 1 and none of those studied by Tonelli et al 2 died after withdrawal of life support, with strong preference being given to the more passive limitation of support, despite it being widely accepted that no significant ethical differences exist between the two. 6 The low parental participation in the decision-making process (9.2% 1 and 20.8% 2 ) and the scarce parental bedside presence at the time of death (14.8% 1 ) were alarming.…”

“…Lago et al 1 and Tonelli et al 2 conducted cross-sectional observational studies in tertiary PICUs in Brazil. The first 1 retrospectively explored patterns of life support limitation (LSL) in 155 deaths of children in three tertiary hospitals in Porto Alegre.…”

“…Advances in end-of-life care in PICUs depend on the complete understanding of the circumstances surrounding death. Lago et al 1 and Tonelli et al 2 have taken an important step in the right direction.…”