Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice:

Larcher, Vic; Craig, Finella; Bhogal, Kiran; Wilkinson, Dominic; Brierley, Joe

doi:10.1136/archdischild-2014-306666

Cited by 217 publications

(238 citation statements)

References 25 publications

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“…Among babies meeting these criteria there were no exclusions. Limiting LST decision was categorised as withdrawal (withdrawal of treatment that has already started), withholding (withholding of treatment that has not been started) and do not resuscitate (DNR) order10 17 based on the highest modality of treatment limitation discussed (eg, baby was categorised under withdrawal of care group where both options of withholding and withdrawal of care were discussed, and categorised under withholding of care where both withholding and DNR were discussed). Babies that died without prior discussion of limiting care were considered as having received appropriate full LST.…”

Section: Methodsmentioning

confidence: 99%

“…The provision of life-sustaining treatment (LST) in such circumstances has been questioned by professionals6 7 and parents 8. Guidelines on clinical, ethical and legal aspects of limiting LST for newborn babies have been produced by regulatory9 professional10 and independent11 bodies in the UK. Similar guidelines are available in the USA12 and other European countries 13…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Aladangady

Shaw²,

Gallagher³

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Aladangady

Shaw²,

Gallagher³

et al. 2016

Arch Dis Child Fetal Neonatal Ed

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“…Ranges were avoided overall for clarity; for example, chest compressions were limited to 3 min, not 3-5 min, to be clear and to better match with the chronology of epinephrine doses. Lastly, in accord with HBB recommendations and the current medical literature, an outcome for stopping resuscitation and death was included and linked to a debrief of both the team and family [19]. This first draft was informally checked for effectiveness against the cognitive aids in medicine assessment tool (CMAT) [2] and Marshall's 4-point [1] criteria by L.U.…”

Section: The Deliberative Processmentioning

confidence: 99%

When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings

Umphrey

Breindahl

Brown³

et al. 2018

Neonatology

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Background: Neonatal resuscitation (NR) combines a set of life-saving interventions in order to stabilize compromised newborns at birth or when critically ill. Médecins Sans Frontières/Doctors Without Borders (MSF), as an international medical-humanitarian organization working particularly in low-resource settings (LRS), assisted over 250,000 births in obstetric and newborn care aid projects in 2016 and provides thousands of newborn resuscitations annually. The Helping Babies Breathe (HBB) program has been used as formal guidance for basic resuscitation since 2012. However, in some MSF projects with the capacity to provide more advanced NR interventions but a lack of adapted guidance, staff have felt prompted to create their own advanced algorithms, which runs counter to the organization's aim for standardized protocols in all aspects of its care. Objectives: The aim is to close a significant gap in neonatal care provision in LRS by establishing consensus on a protocol that would guide MSF field teams in their practice of more advanced NR. Methods: An independent committee of international experts was formed and met regularly from June 2016 to agree on the content and design of a new NR algorithm. Results: Consensus was reached on a novel, mid-level NR algorithm in April 2017. The algorithm was accepted for use by MSF Operational Center Paris. Conclusion: This paper contributes to the literature on decision-making in the development of cognitive aids. The authors also highlight how critical gaps in healthcare delivery in LRS can be addressed, even when there is limited evidence to guide the process.

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“…El objetivo fue actuar como puente hacia la recuperación de la salud o una calidad de vida digna 1,2,3 . La disponibilidad de cuidados intensivos y la sobrevida a diversas patologías, antes incompatibles con la vida, han creado un nuevo escenario.…”

Section: Introductionunclassified

Limitación de tratamiento de soporte vital en una Unidad de Cuidado Intensivo pediátrica chilena: 2004-2014

Dessauer

Benavente

Monje

et al. 2017

Rev. chil. pediatr.

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Palabras clave:Paciente crítico pediátrico, ética, proporcionalidad terapéutica, calidad de vida ResumenObjetivo: Describir las frecuencias y características del proceso de Limitación de Tratamiento de Soporte Vital (LTSV) en pacientes de la Unidad de Cuidados Intensivos Pediátricos (UCI) entre [2004][2005][2006][2007][2008][2009][2010][2011][2012][2013][2014]. Pacientes y Método: Estudio retrospectivo, observacional descriptivo a partir de dos registros de la UCI del Hospital Roberto del Río: 1) ficha clínica individual de seguimiento y 2) ficha de registro de indicadores de calidad incluida LTSV, ambos actualizados diariamente al iniciar la visita clínica. Desde estos registros se analizaron los casos con dilemas bioéticos en los que se propuso LTSV durante su hospitalización en UCI ("LTSV intra-UCI"). Se menciona la población rechazada de ingresar a UCI ("LTSV pre-UCI") y los fallecidos con LTSV en cama básica. Resultados: De 7.821 ingresos a UCI en el 1,51% (118 pacientes) se establece una LTSV: ONI (Orden de No Innovación) en 78,8% de los casos, retiro de medidas terapéuticas en 14,4% y suspensión de ventilación mecánica en 6,8%. En 23,7% el diagnóstico de base fue neurológico u oncológico, para cada uno. La condición fisiopatológica predominante para una LTSV fue neurológica (39%). El tiempo de estadía en UCI triplica el promedio de estada de los egresos totales de UCI, pero es de amplia variabilidad. Conclusiones: Es factible realizar una LTSV en UCI cuando el equipo incorpora esta perspectiva al trabajo diario junto a la familia. Hay una amplia variabilidad individual en las características del proceso de LTSV, propio del ámbito de la ética clínica. Keywords:Pediatric critical care patients, ethics, proportionality, quality of life AbstractObjective: Describe the frequency and characteristics of PICU patients who undergo a process of withholding or withdrawing life-sustaining treatment (LTSV), between 2004 y 2014. Patients and Method: A retrospective, observational descriptive study, using two documents for quality assessment in the PICU of Hospital Roberto del Río: 1) daily individual patient tracking log and 2) daily record

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Making decisions to limit treatment in life-limiting and life-threatening conditions in children: a framework for practice:

Cited by 217 publications

References 25 publications

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

Short-term outcome of treatment limitation discussions for newborn infants, a multicentre prospective observational cohort study

When Helping Babies Breathe Is Not Enough: Designing a Novel, Mid-Level Neonatal Resuscitation Algorithm for Médecins Sans Frontières Field Teams Working in Low-Resource Hospital Settings

Limitación de tratamiento de soporte vital en una Unidad de Cuidado Intensivo pediátrica chilena: 2004-2014

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