At the coalface--medical ethics in practice. Futility and death in paediatric medical intensive care.
We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care.
Great Ormond Street Hospital for Children NHS Trust, London.
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Balfour-Lynn
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D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D004739:England; D005260:Female; D017052:Hospital Mortality; D006776:Hospitals, Pediatric; D006779:Hospitals, Public; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D015931:Intensive Care, Neonatal; D008020:Life Support Care; D008131:London; D008297:Male; D018447:Medical Futility; D012189:Retrospective Studies; D017211:Treatment Failure; D028761:Withholding Treatment