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


METHODS
Retrospective review of medical records.


METHODS
Pediatric ICU in a tertiary care children's hospital.


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


METHODS
Medical record review.


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.
Vernon
D D
DD
Department of Pediatrics, University of Utah, Salt Lake City.
Dean
J M
JM
Timmons
O D
OD
Banner
W
W
Allen-Webb
E M
EM
D001926:Brain Death; D002423:Cause of Death; D002648:Child; D016638:Critical Illness; D005066:Euthanasia, Passive / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data; D006801:Humans; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D016414:Resuscitation Orders; D012189:Retrospective Studies; D014589:Utah / Q000453:epidemiology; D028761:Withholding Treatment