A review of children's dying in a paediatric intensive care unit.
OBJECTIVE
To identify methods of treatment withdrawal, staff support and follow up of families with children dying in a paediatric intensive care unit (PICU).


METHODS
A retrospective review of the 25 children who died in the PICU over 1992 was made.


RESULTS
There were two groups of patients. Group A (16 children) had cessation of active treatment. The decision to cease treatment took a median time of 16 hours and was always made in consultation with other specialists and family. Cessation of artificial ventilation was the most common mechanism of treatment withdrawal. Supplemental morphine was administered to 8 children. Group B (9 children) had continuation of active resuscitation until death. The child's family was present at the time of death in both groups. Te Whanau Atawhai (a Maori liaison group) played an active support role to 18 families. Follow up of bereaved families and staff support was poor.


CONCLUSIONS
Family members are willing to take an active part in the decision making process regarding management of the dying child. This process is multidisciplinary, time consuming and difficult. Valuable assistance for all ethnic groups was gained through the services of Te Whanau Atawhai. Consideration should be given to allowing parents to stay during acute resuscitation of a critically ill child. There were deficiencies of both parental and staff followups. As a consequence, we have introduced a grief education and support service through the, child and family psychiatric service for families and staff.
Anderson
B
B
Paediatric Intensive Care Unit, Children's Health South Pacific, Auckland.
McCall
E
E
Leversha
A
A
Webster
L
L
D002648:Child; D003657:Decision Making; D005190:Family / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008020:Life Support Care; D008297:Male; D008505:Medical Staff, Hospital / Q000523:psychology; D009520:New Zealand; D012944:Social Support; D013727:Terminal Care