Withdrawal of life-support in paediatric intensive care - a study of time intervals between discussion, decision and death

<p>Abstract</p> <p>Background</p> <p>Scant information exists about the time-course of events during withdrawal of life-sustaining treatment. We investigated the time required for end-of-life decisions, subsequent withdrawal of life-sustaining treatment and the time to death.</p> <p>Methods</p> <p>Prospective, observational study in the ICU of a tertiary paediatric hospital.</p> <p>Results</p> <p>Data on 38 cases of withdrawal of life-sustaining treatment were recorded over a 12-month period (75% of PICU deaths). The time from the first discussion between medical staff and parents of the subject of withdrawal of life-sustaining treatment to parents and medical staff making the decision varied widely from immediate to 457 hours (19 days) with a median time of 67.8 hours (2.8 days). Large variations were subsequently also observed from the time of decision to actual commencement of the process ranging from 30 minutes to 47.3 hrs (2 days) with a median requirement of 4.7 hours. Death was apparent to staff at a median time of 10 minutes following withdrawal of life support varying from immediate to a maximum of 6.4 hours. Twenty-one per cent of children died more than 1 hour after withdrawal of treatment. Medical confirmation of death occurred at 0 to 35 minutes thereafter with the physician having left the bedside during withdrawal in 18 cases (48%) to attend other patients or to allow privacy for the family.</p> <p>Conclusions</p> <p>Wide case-by-case variation in timeframes occurs at every step of the process of withdrawal of life-sustaining treatment until death. This knowledge may facilitate medical management, clinical leadership, guidance of parents and inform organ procurement after cardiac death.</p

Palliative Care in Pediatric Oncology

Pediatric palliative care (PPC) in oncology is the active total care of the child’s body, mind, and spirit and involves giving support to the family. Pediatric palliative oncology includes patients across the age spectrum from infancy through young adulthood, and can be embodied as a philosophy of care or applied by an interdisciplinary team of experts. PPC should be initiated at the time of a child’s cancer diagnosis and continued regardless of whether or not the child receives treatment directed at the cancer. PPC aims to prevent and relieve suffering across multiple realms (physical, psychological, social, and existential or spiritual) and enhance quality of life. PPC can be either primary (administered by the primary oncology team) or specialty-focused (administered by an expert or team of experts in PPC), depending on the unique needs of the patient, family, and health care team. Despite evidence demonstrating the benefits of PPC, numerous barriers to its implementation remain. Ongoing education and research are necessary to support consistent access for patients, families, and health care clinicians