Journey from Pediatric Intensive Care to Palliative Care

Abstract

This study suggests that there is a feasible alternative location for withdrawal of intensive care and/or compassionate extubation. The study found that one-third of children transferred to hospice for end-of-life care survived the initial withdrawal of intensive therapy; hence, parallel planning should be discussed prior to transfer to hospice. Information gained from this study has contributed toward the creation of a national care pathway to support extubation within a children's palliative care framework.

Pediatric Palliative Care: Current Evidence and Evidence Gaps

“…38 Whether the involvement of a PPC team leads to earlier limits on resuscitative efforts Technology-based decision aids (eg, videos, apps) for parents and pediatric patients How and where patients die PPC teams help shift the location of death away from PICU and inpatient settings to home and hospice settings. 37,39,41,62 Identification and clarification of factors that influence the preferred location of death Building a better healthcare system Barriers to palliative care Uncertain patient prognosis. 44 Clinician perception of family "readiness" for PPC/ACP discussions.…”

“…40 This can actively change to home deaths with PPC involvement. 41 Among patients with advanced cancer, having open discussions about the location of death is associated with increased home deaths. 42 Although adult HPM providers use a shift in location of death as an impactful outcome of palliative care involvement, whether PPC will, or even should, have the same impact is less clear.…”

Perceptions of a Good Death in Children with Life-Shortening Conditions: An Integrative Review

“…Particularly in the context of pediatric end-of-life care, while 'doing everything possible' seeking further life prolonging treatments, 6 facilitating what is often called a good death can be a parallel goal. 7,8 There has been considerable debate on the notion of what may be meant by a good death and the ramifications this has for care. [9][10][11][12][13][14][15][16] Much literature discusses this concept in relation to adults, but the attributes of a good death in children have not been well described.…”

Pediatric Palliative Transport in Critically Ill Children: A Single Center's Experience and Parents' Perspectives

“…1 However, the reverse transfer of such critically ill patients from intensive care units (ICUs) to their homes for comfort and palliative care, termed palliative transport, is seldom described in medical literature and confined to a few case reports and case series. [2][3][4][5][6][7][8][9] Our Children's Hospital Emergency Transport Service (CHETS) is a dedicated neonatal and pediatric critical care transport service established in 2004 and performs on average 90 missions annually, the majority of which comprises the retrieval of critically ill children from emergency departments or private hospitals locally and in the region. 10 The CHETS team routinely comprises of an ICU trained physician and nurse, with a dedicated pediatric mobile ICU for road retrievals and is also equipped to travel by air ambulance when necessary.…”