[Life support limitation at three pediatric intensive care units in southern Brazil].
OBJECTIVE
To describe causes of death and factors involved in the decision-making process related to life support limitation at three university-affiliated pediatric intensive care units in the south of Brazil.


METHODS
A retrospective study was conducted, based on a review of the medical records of all deaths occurring during 2002 at three pediatric intensive care units in Porto Alegre. Three previously trained pediatric fellows from each service performed the study. Data were assessed relating to general case characteristics, causes of death (failed cardiopulmonary resuscitation, brain death, do-not-resuscitate orders, withholding or withdrawing life-sustaining treatment -- the last three modes were classified as the life support limitation group), length of stay in hospital, end-of-life plans and the participation of patients families and Ethics Committees. The Student t test, Mann Whitney, chi-square, odds ratio and multivariate analyses were used for comparisons.


RESULTS
Close to 53.3% of fatal cases had received full cardiopulmonary resuscitation. The incidence of life support limitation was 36%, with statistical differences (p = 0.014) between the three hospitals (25 versus 54.3 and 45.5%, respectively). The most frequent form of life support limitation was a do-not-resuscitate order (70%). Life support limitation was associated with the presence of chronic disease (odds ratio = 8.2; 95%CI 3.2-21.3) and length stay in the pediatric intensive care unit (odds ratio = 4.4; 95%CI 1.6-11.8). The rate of involvement of families and Ethics Committees in the decision-making process was lesser than 10%.


CONCLUSIONS
Cardiopulmonary resuscitation is offered more frequently than is observed in northern countries. In contrast, life support limitation is offered through do-not-resuscitate orders. These findings and the low participation of the families in the decision-making process reflect the difficulties to be overcome by those professionals who are responsible for handling critically ill children in southern Brazil.
Lago
Patrícia M
PM
Hospital das Clínicas de Porto Alegre, Porto Alegre, RS. lagopatricia@terra.com.br
Piva
Jefferson
J
Kipper
Délio
D
Garcia
Pedro Celiny
PC
Pretto
Cristiane
C
Giongo
Mateus
M
Branco
Ricardo
R
Bueno
Fernanda
F
Traiber
Cristiane
C
Araújo
Taisa
T
Wortmann
Daniela
D
Librelato
Graziele
G
Soardi
Deise
D
D001938:Brazil; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D003643:Death; D004812:Epidemiologic Methods; D004992:Ethics, Medical; D005260:Female; D006801:Humans; D015278:Intensive Care Units, Pediatric; D008020:Life Support Care / Q000941:ethics; D008297:Male; D011368:Professional-Family Relations; D016414:Resuscitation Orders; D013727:Terminal Care / Q000941:ethics