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

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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)

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