Dying in the intensive care unit: collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units.
OBJECTIVE
Describe modes of death and factors involved in decision-making together with life support limitation (LSL) procedures.


METHODS
Prospective, descriptive, longitudinal, and noninterventional study.


METHODS
Sixteen pediatric intensive care units in Argentina.


METHODS
Every patient who died during a 1-yr period was included.


RESULTS
Age, sex, length of stay (LOS), primary and admission diagnosis, underlying chronic disease (CD), postoperative condition (PO). Deaths were classified in four groups: a) failed cardiopulmonary resuscitation (CPR); b) do-not-resuscitate (DNR) status; c) withholding or withdrawing life-sustaining treatment (WH/WD); and d) brain death (BD). Justifications were classified as a) imminent death; b) poor long-term prognosis; c) poor quality of life; and d) family request. Data were collected from medical records and interviews with the attending physicians. Descriptive statistics were performed. Differences among groups were analyzed through contingency tables and analysis of variance when required. Relative risks and confidence intervals of variables potentially related to LSL were analyzed, and logistic regression was performed. There were 6358 admissions and 457 deaths. CPR was performed in 52%, DNR in 16%, WH/WD in 20%, and BD in 11% of dead patients. BD patients were older, LOS and CD prevalence were higher in the WH/WD group. Inotropic drugs were the most frequently limited treatment in 110 patients (55%), CPR in 72 (35.6%), and mechanical ventilation in 63 (31%). Imminent death was the most frequently reported justification for LSL. CD and more staff were associated with a higher probability of LSL.


CONCLUSIONS
Most of the patients in Argentina underwent CPR before their death. We have a high proportion of patients with CD (65%) and low BD diagnosis. PO condition decreased LSL probability in chronically ill patients. Do-not-resuscitate orders and withholding new treatments were the most common LSL. Active withdrawal was exceptional. The Ethics Committee was consulted in 5% of the LSL population.
Althabe
María
M
Hospital de Pediatría "J. P. Garrahan," Buenos Aires, Argentina.
Cardigni
Gustavo
G
Vassallo
Juan C
JC
Allende
Daniel
D
Berrueta
Mabel
M
Codermatz
Marcela
M
Córdoba
Juan
J
Castellano
Silvia
S
Jabornisky
Roberto
R
Marrone
Yolanda
Y
Orsi
Maria C
MC
Rodriguez
Gabriela
G
Varón
Juan
J
Schnitzler
Eduardo
E
Tamusch
Héctor
H
Torres
José M
JM
Vega
Laura
L
D001118:Argentina; D002648:Child; D002675:Child, Preschool; D003657:Decision Making; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric / Q000706:statistics & numerical data*; D007902:Length of Stay; D008020:Life Support Care / Q000941:ethics*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D016414:Resuscitation Orders