Modos de morrer na UTI pediátrica de um hospital terciário

Carvalho, Paulo Roberto Antonacci; Rocha, Taís Sica da; Espírito-Santo, António; Lago, Patrícia Miranda do

doi:10.1590/s0104-42302001000400035

Cited by 28 publications

(47 citation statements)

References 17 publications

(38 reference statements)

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“…In the last decade, however, little has been known about LSL practices in Brazil. 5,12 The present study was carried out to assess the modes of death at three PICUs in southern Brazil in 2002, describing the incidence of LSL and related factors.…”

Section: Introductionmentioning

confidence: 99%

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

Lago¹,

Piva²,

Kipper³

et al. 2005

J. Pediatr. (Rio J.)

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Objectives: To describe causes of death and factors involved in the decision-making process related to life support limitation at three university-affiliated pediatric intensive care units in the south of Brazil.Methods: A retrospective study was conducted, based on a review of the medical records of all deaths occurring during 2002 at three pediatric intensive care units in Porto Alegre. Three previously trained pediatric fellows from each service performed the study. Data were assessed relating to general case characteristics, causes of death (failed cardiopulmonary resuscitation, brain death, do-not-resuscitate orders, withholding or withdrawing lifesustaining treatment -the last three modes were classified as the life support limitation group), length of stay in hospital, end-of-life plans and the participation of patients families and Ethics Committees. The Student t test, Mann Whitney, chi-square, odds ratio and multivariate analyses were used for comparisons.Results: Close to 53.3% of fatal cases had received full cardiopulmonary resuscitation. The incidence of life support limitation was 36%, with statistical differences (p = 0.014) between the three hospitals (25 versus 54.3 and 45.5%, respectively). The most frequent form of life support limitation was a do-not-resuscitate order (70%). Life support limitation was associated with the presence of chronic disease (odds ratio = 8.2; 95%CI 3.2-21.3) and length stay in the pediatric intensive care unit (odds ratio = 4.4; 95%CI 1.6-11.8). The rate of involvement of families and Ethics Committees in the decision-making process was lesser than 10%.Conclusions: Cardiopulmonary resuscitation is offered more frequently than is observed in northern countries. In contrast, life support limitation is offered through do-not-resuscitate orders. These findings and the low participation of the families in the decision-making process reflect the difficulties to be overcome by those professionals who are responsible for handling critically ill children in southern Brazil.J Pediatr (Rio J). 2005;81(2):111-7: Death, ethics, pediatric intensive care, forgoing life support, do-notresuscitate orders.

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Section: Introductionmentioning

confidence: 99%

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

Lago¹,

Piva²,

Kipper³

et al. 2005

J. Pediatr. (Rio J.)

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“…Other series have registered similar findings with respect of severe or debilitating chronic diseases. 11,13 The place of death analysis stratified by chronic disease state confirms the tendency towards treatment limitation in the neonatal unit. With respect of physiological instability as measured by the scores, no significant difference was observed in risks (PRISM/DORA and SNAPPE-II) between the different care categories.…”

Section: Discussionmentioning

confidence: 79%

“…In general, developing countries exhibit a more conservative profile. 11,12 The only Brazilian study of this type (Carvalho et al, 2001), 11 undertaken at a pediatric ICC, revealed how common limitation of therapy can be in our country (40.9% of the sample).…”

Section: Discussionmentioning

confidence: 89%

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

Tonelli¹,

Mota²,

Oliveira³

2005

J. Pediatr. (Rio J.)

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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)

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“…1. Strategies adopted for the terminally ill patient in the pediatric intensive care unit Nine (9) studies describing the manner of dying in the PICU that supported decisions to forgo life-sustaining treatment, such as withhold (WH), withdraw (WD), or do-not-resuscitate (DNR) orders were identified, with 4 of them being cohort studies and 5 being retrospective studies [14][15][16][17][18][19][20][21][22] . Some articles referred to brain death (BD) as a type of death, but obviously, a patient with BD is not classified as a terminally ill patient.…”

Section: Resultsmentioning

confidence: 99%

Ethical aspects in the management of the terminally ill patient in the pediatric intensive care unit

Torreão

Pereira²,

Troster³

2004

Rev. Hosp. Clin.

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OBJECTIVE: To identify the prevalence of management plans and decision-making processes for terminal care patients in pediatric intensive care units. METHODOLOGY: Evidence-based medicine was done by a systematic review using an electronic data base (LILACS, 1982 through 2000) and (MEDLINE, 1966 through 2000). The key words used are listed and age limits (0 to 18 years) were used. RESULTS: One hundred and eighty two articles were found and after selection according to the exclusion/inclusion criteria and objectives 17 relevant papers were identified. The most common decisions found were do-not-resuscitation orders and withdrawal or withholding life support care. The justifications for these were "imminent death" and "unsatisfatory quality of life". CONCLUSION: Care management was based on ethical principles aiming at improving benefits, avoiding harm, and when possible, respecting the autonomy of the terminally ill patient.

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Modos de morrer na UTI pediátrica de um hospital terciário

Cited by 28 publications

References 17 publications

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

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

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

Ethical aspects in the management of the terminally ill patient in the pediatric intensive care unit

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