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 Meetings between the medical team and family were documented for 15 of 16 children (93.8%) before treatment was withdrawn.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.
"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      . In addition, difficulty in reaching consensus is usually resolved over time  , and the approach to the use of sedatives and neuromuscular blockers is subject to individual preferences   . "
[Show abstract][Hide abstract] ABSTRACT: Introduction:
Withholding life-sustaining treatments (WHLST) and withdrawing life-sustaining treatments (WDLST) occur in most intensive care units (ICUs) around the world to varying degrees.
Speakers from invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress in 2013 with an interest in ethics were approached to participate in an ethics round table. Participants were asked if they agreed with the statement "There is no moral difference between withholding and withdrawing a mechanical ventilator." Differences between WHLST and WDLST were discussed. Official statements relating to WHLST and WDLST from intensive care societies, professional bodies, and government statements were sourced, documented, and compared.
Sixteen respondents stated that there was no moral difference between withholding or withdrawing a mechanical ventilator, 2 were neutral, and 4 stated that there was a difference. Most ethicists and medical organizations state that there is no moral difference between WHLST and WDLST. A review of guidelines noted that all but 1 of 29 considered WHLST and WDLST as ethically or legally equivalent.
Most respondents, practicing intensivists, stated that there is no difference between WHLST and WDLST, supporting most ethicists and professional organizations. A minority of physicians still do not accept their equivalency.
Journal of Critical Care 06/2014; 29(6). DOI:10.1016/j.jcrc.2014.06.022 · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Precision liquid crystal optical elements are proving effective for dynamic compensation in gain equalization, channel equalization, and similar applications. The structure and performance of these devices is presented, for both reflective and transmissive systems.
All-Optical Networking: Existing and Emerging Architecture and Applications/Dynamic Enablers of Next-Generation Optical Communications Systems/Fast Optical Processing in Optical Transmission/VCSEL and Microcavity Lasers. 2002 IEEE/LEOS Summer Topi; 02/2002
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