Mechanical ventilation for respiratory failure in children with severe neurological impairment: is it futile medical treatment?
OBJECTIVE
To assess outcome for children with severe neurological impairment receiving invasive mechanical ventilation for respiratory failure.


METHODS
Medical charts for all such children treated in our intensive care unit (ICU) between January 2003 and July 2008 were reviewed. Outcomes were compared with those for children with moderate neurological impairment.


RESULTS
Twenty-two children with severe neurological impairment were included (nine females, 13 males; median age 7y 10mo; range 4mo-17y). The median duration of mechanical ventilation was 16 days. Six children had an uneventful 1-year survival, the others required reintubation or readmission to the ICU, or died. Eleven children were still alive 1 year after discharge from the ICU. Nine patients died of respiratory failure. None of the children in the severe group died of a heart defect. Eleven children with moderate neurological impairment were included (eight females, three males; median age 1y 1mo, range 4mo-13y). Four children had an uneventful 1-year survival. Eight children were still alive 1 year after discharge from the ICU. Two of the three non-survivors died of their heart defects.


CONCLUSIONS
Mechanical ventilation for respiratory failure in children with severe neurological impairment is complex and associated with limited survival. However, it cannot be regarded as futile medical treatment. Further studies are urgently needed for the rational guidance of clinical decision-making.
van Gestel
Josephus P J
JP
Division of Paediatrics, Paediatric Intensive Care Unit, University Medical Center Utrecht, Wilhelmina Children's Hospital, Utrecht, the Netherlands.
Robroch
Afke H
AH
Bollen
Casper W
CW
Van Der Ent
Cornelis K
CK
Van Vught
Adrianus J
AJ
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007362:Intensive Care Units; D008297:Male; D018447:Medical Futility; D009422:Nervous System Diseases / Q000150:complications* / Q000401:mortality; D012121:Respiration, Artificial / Q000401:mortality / Q000706:statistics & numerical data; D012131:Respiratory Insufficiency / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome