Moore P, Kerridge I, Gillis J, et al. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature

Orange Base Hospital, Orange, Australia.
Journal of Paediatrics and Child Health (Impact Factor: 1.15). 07/2008; 44(7-8):404-8. DOI: 10.1111/j.1440-1754.2008.01353.x
Source: PubMed


To examine withdrawal and limitation of life-sustaining treatment (WLST) in an Australian paediatric intensive care unit (PICU) and to compare this experience with published data from other countries.
Retrospective chart review and literature review.
Review of 12 months of patient records from a tertiary Australian children's teaching hospital. Medline search using relevant key words focusing on death and PICU.
Twenty of 27 deaths (74%) followed either WLST (n = 16) or Do Not Resuscitate (DNR) orders (n = 4); five children failed cardiopulmonary resuscitation (CPR); and two children were brain-dead. Meetings between the medical team and family were documented for 15 of 16 children (93.8%) before treatment was withdrawn. The average time between withdrawal of life support and death was 13 min. A review of the English-language literature revealed that 18-65% occurring in PICUs worldwide follow WLST and/or institution of DNR orders. Rates were higher (30-65%) in North America and Europe than elsewhere. Most PICU deaths occurred within 3 days of admission. North American and British parents appear to be involved in decisions regarding withdrawal and limitation of treatment more often than parents in other countries.
Withdrawal and limitation of life-sustaining treatment was more common in an Australian children's hospital ICU than has been reported from other countries. Details of discussion with parents, including the basis for any decision to WLST, were almost always documented in the patient's medical record.

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    • "There are also regional differences worldwide on how decisions regarding withholding or withdrawing life-sustaining decisions are made and to what extent families are involved. In most cases, decisions are made after discussion among the medical team, and parents may be informed of the decision and may or may not be asked for their permission [20] [21] [22] [23] [24] [25]. In addition, difficulty in reaching consensus is usually resolved over time [26] [27], and the approach to the use of sedatives and neuromuscular blockers is subject to individual preferences [23] [28] [29]. "
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