Evaluating end of life practices in ten Brazilian paediatric and adult intensive care units.
OBJECTIVE
To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years.


METHODS
Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of admission to the ICU and brain death were excluded.


METHODS
Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (kappa=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann-Whitney U test, chi(2) test and RR were used for data comparison.


RESULTS
1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). A 'do not resuscitate' order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p<0.001).


CONCLUSIONS
Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation.
Piva
Jefferson
J
School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil. jpiva@terra.com.br
Lago
Patrícia
P
Othero
Jairo
J
Garcia
Pedro Celiny
PC
Fiori
Renato
R
Fiori
Humberto
H
Borges
Luiz Alexandre
LA
Dias
Fernando S
FS
D000328:Adult; D000368:Aged; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003657:Decision Making; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008020:Life Support Care / Q000379:methods* / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013727:Terminal Care / Q000379:methods*; D028761:Withholding Treatment / Q000706:statistics & numerical data