Discussing withholding and withdrawing of life‐sustaining medical treatment in paediatric inpatients: Audit of current practice

Stark, Zornitza; Hynson, Jenny; Forrester, Mike

doi:10.1111/j.1440-1754.2008.01352.x

Cited by 34 publications

(40 citation statements)

References 25 publications

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“…A variety of studies over the last two decades have highlighted the intensive care setting as the central, and in some instances nearly exclusive, place for making life and death decisions within a modern children's hospital [1-5]. Although physician, nursing, ethical and legal aspects have since been important foci of research in this difficult-to-study area [6,7], scant information exists about the time-course of the process of withdrawal of life-sustaining treatment from the moment of discussion to actual death.…”

Section: Introductionmentioning

confidence: 99%

Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

Oberender

Tibballs

2011

BMC Pediatr

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BackgroundScant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death.MethodsProspective, observational study in the ICU of a tertiary paediatric hospital.ResultsData on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths). The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days) with a median time of 67.8 hours (2.8 days). Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days) with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48%) to attend other patients or to allow privacy for the family.ConclusionsWide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.

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Section: Introductionmentioning

confidence: 99%

Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

Oberender

Tibballs

2011

BMC Pediatr

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“…7,8 Research from Australia, 4,5,9 the United States, 10,11 and the United Kingdom 1 has found that children most frequently die as a result of withdrawal of life support, whereas studies from Brazil, 3 France, and Eastern and Central Europe 2 identify that most children die in PICUs as a result of failed cardiopulmonary resuscitation. Some have argued that this can be attributed largely to cultural differences related to end-oflife care practices and the social acceptance of the death of a child.…”

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confidence: 99%

Family Experience and PICU Death: A Meta-Synthesis

et al. 2015

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“…Those 2 singleinstitution studies showed limitation of support for 74% and 84% of pediatric deaths. 15,16 The scarcity of literature from the United States in the previous decade and the overall paucity of pediatric multiinstitutional studies led us to examine the patterns of pediatric deaths and end-of-life care in PICU settings in a multiinstitutional cohort from across the country. Are we still limiting support in just more than one-third of pediatric deaths, as shown in 16 US PICUs in 1994, or are we closer to the numbers reported recently from Australia?…”

mentioning

confidence: 99%

“…Are we still limiting support in just more than one-third of pediatric deaths, as shown in 16 US PICUs in 1994, or are we closer to the numbers reported recently from Australia? 7,15,16 We aimed specifically to understand how frequently limitations of support occurred at the end of life in PICU settings in the United States and sought to identify variations in end-oflife practices related to specific PICU and patient variables.…”

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confidence: 99%

Alterations in End-of-Life Support in the Pediatric Intensive Care Unit

2010

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WHAT'S KNOWN ON THIS SUBJECT:Studies from the 1990s demonstrated limitation of end-of-life support in 30% to 58% of US PICU deaths. Little has been published from the United States since that time. More-recent publications from Australia showed limitation in 74% to 84% of deaths. WHAT THIS STUDY ADDS:The authors address a gap in the literature by describing recent end-of-life support practices in 30 PICUs across the United States. abstract OBJECTIVE: Our purpose was to examine alterations in end-of-life support in a multiinstitutional sample of PICUs. METHODS:This was a retrospective, descriptive study. Variables collected included end-of-life support category, race, length of stay, operative status, reason for admission, and Pediatric Index of Mortality 2 score, as well as the number of ICU beds and the presence of trainees. RESULTS:There were 1745 deaths at 35 institutions between January 1, 2004, and September 30, 2005. Of those, 1263 had complete data and were analyzed. The end-of-life support category distribution was as follows: brain death, 296 (23%); do not resuscitate, 205 (16%); limitation of support, 36 (3%); withdrawal of support, 579 (46%); no limitation, 124 (10%); no advance directives, 23 (2%). For further analyses, end-of-life support categories were grouped as limitation (ie, do not resuscitate, limitation of support, or withdrawal of support) versus no limitation (ie, no limitation or no advance directive). Brain death was not included in further analyses. The majority of deaths were in the limitation group (n ϭ 820 [85%]), and 12 (40%) of 30 institutions had 100% of deaths in this group. There were significant differences between institutions (P Ͻ .001). Decisions for limitation were seen less frequently in the black race (112 [76%] of 147 deaths; P ϭ .037) and in institutions with no trainees (56 [69%] of 81 deaths; P Ͻ .001). CONCLUSIONS:

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Discussing withholding and withdrawing of life‐sustaining medical treatment in paediatric inpatients: Audit of current practice

Cited by 34 publications

References 25 publications

Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

Family Experience and PICU Death: A Meta-Synthesis

Alterations in End-of-Life Support in the Pediatric Intensive Care Unit

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