Modes of death in the pediatric intensive care unit: Withdrawal and limitation of supportive care

    loading  Checking for direct PDF access through Ovid

Abstract

Objective:

To determine the frequency of withdrawal or limitation of supportive care for children dying in a pediatric intensive care unit (ICU).

Design:

Retrospective review of medical records.

Setting:

Pediatric ICU in a tertiary care children's hospital.

Patients:

All children dying in the pediatric ICU over a 54-month period (n = 300).

Interventions:

Medical record review.

Measurements and Main Results:

Data recorded for each patient included diagnosis, mode of death, and whether the child was brain dead. Each patient was assigned to one of the following mode of death categories: brain dead; active withdrawal of supportive care (meaning removal of the endotracheal tube); failed cardiopulmonary resuscitation; allowed to die without cardiopulmonary resuscitation (do-not-resuscitate status). A total of 300 patients were identified. Diagnoses included postoperative congenital heart disease (n = 56), head trauma (n = 38), near-miss sudden infant death syndrome (n = 28), pneumonia (n = 22), sepsis (n = 21), near-drowning (n = 21), various anoxic insults (n = 20), multiple trauma (n = 17), and patients with other diagnoses (n = 77). Mode of death was active discontinuation of support in 95 (32%) patients, do-not-resuscitate status in 78 (26%), brain death in 70 (23%), and failed cardiopulmonary resuscitation in 57 (19%).

Conclusions:

In a large, multidisciplinary pediatric ICU, the most common mode of death was active withdrawal of support. In addition, more than half (173/300, 58%) of children dying in the pediatric ICU underwent either active withdrawal or limitation (do-not-resuscitate status) of supportive care. (Crit Care Med 1993; 21:1798–1802)

Related Topics

    loading  Loading Related Articles