title: [Epidemiology and evaluation of withdrawing and withholding of treatment procedure in a pediatric intensive care unit].
abstract: OBJECTIVE
  Leonetti Law of 2005 concerns procedures for questioning about the appropriateness of initiating or maintaining life-sustaining treatments. Decision of withdrawing and withholding treatment has long been practiced by neonatologists, adult and pediatricians intensivists. In this regard, the recommendations of societies encourage medical teams to assess their practices to improve them. Our evaluation is based on the document of the Ethics Committee of SRLF edited in 2010.
  
  
  METHODS
  We achieved a retrospective evaluation of professional practices of the transcription of our decisions of withdrawing and withholding treatment.
  
  
  METHODS
  This study included all children (95 patients) who have had a questioning about life-sustaining treatment of ICU between March 2008 and August 2011 in the pediatric intensive care unit of Children's Hospital of Lyon. Our evaluation is based on the document of the Ethics Committee of French Society of intensive care (SRLF) edited in 2010. We collected epidemiological data on children concerned by questioning about the appropriateness of initiating or maintaining LST and an evaluation of the transcription of our procedures for LST in our folders. Evaluation included 40 cases: 20 folders randomly selected prior an information meeting (January 2011) which were compared with 20 cases occurred consecutively after this information. This meeting was intended to remind recommendations of good practice and principal points of the law. The main assessment measure was the improvement of the practices respecting criteria of the document of the Ethics Committee of SRLF modified for pediatric care.
  
  
  RESULTS
  Epidemiological data on procedures are comparable to literature data. Concerning the evaluation of our practices before/after a briefing and highlighted a tendency to the improvement without statistically significance. The transcription of reflection and the arguments of decision of withdrawing and withholding treatment and evaluation of pain was the points who need improvement. Finally, despite the positive developments in the therapeutic use of analgesics and sedatives, pain continues to be undervalued.
  
  
  CONCLUSIONS
  The evaluation of professional practices is recommended to improve the procedures of questioning about life-sustaining treatments have become an area of expertise in intensive care.
authors.affiliation: Service de réanimation pédiatrique, hôpital Femme-Mère-Enfant, 59 boulevard Pinel, Lyon-Bron, France. fabienne.bordet@chu-lyon.fr
authors.forename: F
authors.initials: F
authors.lastname: Bordet
authors.forename: G
authors.initials: G
authors.lastname: Bouvier-Jambon
authors.forename: C
authors.initials: C
authors.lastname: Didier
authors.forename: E
authors.initials: E
authors.lastname: Javouhey
mesh_terms: D000700:Analgesics / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003422:Critical Care / Q000706:statistics & numerical data; D004363:Drug Utilization; D028741:Ethics Committees, Clinical; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use; D007223:Infant; D015278:Intensive Care Units, Pediatric / Q000941:ethics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D007902:Length of Stay; D008020:Life Support Care / Q000706:statistics & numerical data; D008297:Male; D010147:Pain Measurement; D010290:Parents; D016414:Resuscitation Orders; D012189:Retrospective Studies; D028761:Withholding Treatment / Q000941:ethics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*
chemical_list: D000700:Analgesics; D006993:Hypnotics and Sedatives