Summary:
Introduction: PICU receives patients in a severe clinical condition that need
careful monitoring and intensive supportive treatment. Patients with free past
medical history, as well as patients with cancer, chronic disease and severe
congenital genetic diseases are admitted, whenever their life is in danger.
The evolution of medicine has led to prolongation of life of healthy children,
but also to pain prolongation in children with severe chronic diseases.
Moreover, physicians admit that the cultural backround in addition to the legal
gap makes difficult the transition from aggressive supportive treatment to
palliative care.
Aim: To study the morbidity in PICU, the frequency of the symptoms during
admition, the mortality rate and the correlation with previous medical
problems, and to observe whether the strategy of limitation or withdrawal of
treatment is applied in Greek PICU.
Design: It is a retrospective, descriptive, longitudinal, non interventional
study.
Material and methods: All patients who were admitted in PICU of P&A Kyriakou
University CHildrens’ Hospital from 1/1/2008 to 31/12/2009 were included.
The data were collected from the detailed discharged summaries and the medical
notes. We collected data regarding age, gender, past medical history (chronic
disease, cancer, developmental delay), the medical support applied (mechanical
ventilation, resuscitation, inotropes, nonkidnay haemodilusion) and duration of
admission.
In the patients who died, we collected extra details, regarding the source of
admission, race, the disease reversibility, the diagnostic uncertainty, the
psychological support of family.
Results: Aggressive resuscitation with cardiac massage is the first
life-sustaining treatment, which is limited, followed by inotropes. In
contrast, mechanical ventilation is the last treatment to forgo and usually
happens in cases of brain death.
Severe medical history, poor neurologic outcome, chronic disease and cancer,
influence the decision to limit intensive care support. There is no clear
documentation regarding limitation of life sustaining treatment in patients’
notes, but arises after statistical analysis of the data.
Keywords:
Limitation, Resuscitation, Pediatric intensive care unit death, Do not resuscitation orders , Withdrawal
