title: A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment.
abstract: OBJECTIVE
  To examine physiologic and therapeutic changes following withdrawal of life-sustaining treatment in children.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  University-affiliated tertiary care pediatric hospital.
  
  
  METHODS
  All patients who had life-sustaining treatment withdrawn over a 5-yr period.
  
  
  METHODS
  None.
  
  
  RESULTS
  A total of 125 charts were examined to obtain 50 in which the terminal event preceding death was withdrawal of life-sustaining treatment. Data are expressed as median (1st, 3rd quartiles). Median hospital stay before death was 20 days (1st and 3rd quartiles, 8 and 30). Median time from decision to withdraw life-sustaining treatment to actual withdrawal was 30 mins (1st and 3rd quartiles, 10 and 180). All interventions were simultaneously discontinued in 80% of patients with mechanical ventilation followed by vasopressors being most common. No patients had stepwise reduction in ventilator rate before discontinuing the mechanical ventilation. Devices were rarely removed from patients including endotracheal tubes. Time from withdrawal of life-sustaining treatment to death was 15 mins (5, 30); only seven patients took >60 mins to die. Multivariable analysis (Kruskal-Wallis test) of various factors revealed simultaneous withdrawal of life-sustaining treatment, female gender, and not having received renal therapy as hastening death.
  
  
  CONCLUSIONS
  Forgoing life-sustaining treatment in a small cohort of children at a single institution follows a pattern: Most cases occur after prolonged intensive care unit stays, withdrawal of treatment occurs almost immediately after the decision to withdraw, most treatments are withdrawn simultaneously rather than sequentially, and most patients die within minutes of life-sustaining treatment cessation. This is the first pediatric study to report the time to death after withdrawal of life-sustaining treatment and factors associated with shorter time to death in children.
authors.affiliation: University of Pittsburgh Department of Critical Care Medicine, Critical Care Medicine, Pittsburgh, PA, USA.
authors.forename: Christine A
authors.initials: CA
authors.lastname: Zawistowski
authors.forename: Michael A
authors.initials: MA
authors.lastname: DeVita
mesh_terms: D000293:Adolescent; D000700:Analgesics / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005066:Euthanasia, Passive; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D019148:Neuromuscular Blockade; D010166:Palliative Care; D010290:Parents / Q000523:psychology; D010358:Patient Participation; D012189:Retrospective Studies; D013997:Time Factors
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives