title: Forgoing life-sustaining treatments: how the decision is made in French pediatric intensive care units.
abstract: OBJECTIVE
  The decision to forgo life support is frequently made in pediatric intensive care units (PICUs). A group of experts is currently preparing recommendations for guidelines concerning this decision-making process in France. We have performed a prospective study to help the experts. This study documents how children die in French PICUs and how the decision to limit life support is made.
  
  
  METHODS
  A multicenter, prospective, cross-sectional study.
  
  
  METHODS
  Thirty-three multidisciplinary PICUs in university hospitals.
  
  
  METHODS
  All consecutive deaths were recorded over a 4-month period. Children who died after a medical decision to forgo life-sustaining treatment were included in group 1 and children who died from other causes were included in group 1.
  
  
  RESULTS
  A total of 264 consecutive children died, 40.1% from group 1 and 59.8% from group 2. Patients of both groups were primarily admitted for acute respiratory failure (group 1, 50.8%; group 2, 52.6%). Neurologic emergencies were more frequent in patients in group 1, whereas patients with cardiovascular failures were more frequent in group 2. When there was a question of whether to pursue life-sustaining treatment, the parents' opinions were recorded in 72.1% of cases. A specific meeting was called to make this decision in 80.1% of cases. This meeting involved the medical staff in all cases. Parents were aware of the meeting in 10.7% of cases. The conclusion of the meeting was reported to the parents in 18.7% of cases and documented in the patient's medical record in 16% of cases. Experts who were not members of the PICU staff were invited to give their opinion in 62.2% of cases.
  
  
  CONCLUSIONS
  The decision to forgo life-sustaining treatment is frequently made for children dying in French PICUs. Guidelines must be available to help the medical staff reach this decision. Knowledge of the decision-making process in French PICUs provides the experts with information needed to elaborate such recommendations.
authors.affiliation: Service de Réanimation Pédiatrique, Assistance Publique-Hôpitaux de Paris, Hôpital de Bicêtre, Bicêtre, France. denis.devictor@bct.ap-hop-paris.fr
authors.forename: D J
authors.initials: DJ
authors.lastname: Devictor
authors.forename: D T
authors.initials: DT
authors.lastname: Nguyen
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D005602:France; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008020:Life Support Care; D008297:Male; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D011368:Professional-Family Relations; D011446:Prospective Studies