Cuidados paliativos en la unidad de cuidados intensivos pediátricos
Palabras clave:
CUIDADOS PALIATIVOS, CUIDADOS CRÍTICOS, UNIDADES DE CUIDADO INTENSIVO PEDIÁTRICO
Resumen
La aplicación de los avances tecnológicos en pediatría ha generado un fenómeno no deseado: su uso en quienes no se benefician de los mismos. La confianza en el uso de la tecnología, en el marco de una compleja red de factores, ha determinado un cambio en la actitud que la sociedad tiene frente a la muerte.
Los cuidados paliativos permiten focalizar la atención en aquellos pacientes con enfermedades que ponen en riesgo su vida, puedan o no recuperarse. Con esta concepción, en las unidades de cuidado intensivo pediátricas, los cuidados paliativos deben implementarse junto con los curativos, independientemente de que exista o no un plazo para la ocurrencia de la muerte.
Este encuadre solo es posible mediante una formación integral que jerarquice el cuidado paliativo en el trabajo diario de las unidades, en los cursos de postgrado de pediatría intensiva y en las actividades de educación médica continua.
Citas
(1) American Academy of Pediatrics. Commttee on Bioethics. Guidelines on foregoing life-sustaining medical treatment. Pediatrics 1994; 93(3):532-6.
(2) Hynson JL, Gillis J, Collins JJ, Irving H, Trethewie SJ. The dying child: how is care different? Med J Aust 2003; 179 (6 Suppl): S20-2.
(3) Lago P, Piva J, Kipper D, et al. Limitacão de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil. J Pediatr (Rio J) 2005; 81(2): 111-7.
(4) Salas Arrambide M, Gabaldón Poc O, Mayoral Miravete JL, Pérez-Yarza EG, Amayra Caro. El pediatra ante la muerte del niño: integración de los cuidados paliativos en la unidad de cuidados intensivos pediátricos. An Pediatr (Barc) 2005; 62(5): 450-7.
(5) Rotta, A. Tellechea. Cuidados no final da vida em pediatria: muito mais que uma luta contra a entropia. J Pediatr (Rio J) 2005; 81(2): 93-5.
(6) Martin A. Off-season events. Child Adolesc Psychiatric Clin N Am 2006; 15(3): xiii-xv.
(7) Glazer JP, Hilden MJ, Poltorak DY. Pediatric palliative medicine. Child Adolesc Psychiatric Clin N Am 2006; 15(3): xvii-xx.
(8) Poltorak DY, Glazer JP. The development of children’s understanding of death: cognitive and psychodynamic considerations. Child Adolesc Psychiatric Clin N Am 2006; 15(3): 567-73.
(9) Bartel DA, Engler AJ, Natale JE, Misra V, Lewin AB, Joseph JG. Working with families of suddenly and critically ill children: physician experiences. Arch Pediatr Adolesc Med 2000; 154(11): 1127-34.
(10) Kipper DJ. Final de vida em crianças: aspectos técnicos e bioéticos. Porto Alegre: EDIPUCRS, 2007.
(11) Burns JP, Mitchell C, Outwater KM, Geller M, Griffith JL, Todres ID, et al. End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment. Crit Care Med 2000; 28(8): 3060-6.
(12) Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, et al. Recommendations for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine. Crit Care Med 2001; 29(12): 2332-48.
(13) Althabe M, Cardigni G, Vasallo JC, Allende D, Berrueta M, et al. Dying in the intensive care unit: collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units. Pediatr Crit Care Med 2003; 4(2): 164-9.
(14) Studdert DM, Burns JP, Mello MM, Puopolo AL, Truog RD, Brennan TA. Nature of conflict in the care of pediatric intensive care patients with prolonged stay. Pediatrics 2003; 112(3 Pt 1): 553- 8.
(15) Humphry D, Wickett A. El derecho a morir: comprender la eutanasia. Barcelona: Tusquets, 1989.
(16) Morin E. El hombre y la muerte. 3 ed. Barcelona: Kairós, 1999.
(17) Ariés PH. El hombre ante la muerte. 4 ed. Madrid: Santillana, 1999.
(18) Callahan D. Living and dying with medical technology. Crit Care Med 2003; 31(5 Suppl): S344-6.
(19) Garros D. Uma boa morte em UTI pediátrica: é isso possível? J Pediatr (Rio J) 2003; 79(supl. 2): S243-54.
(20) Rabow MW, Hardie GE, Fair JM, Mcphee SJ. End-of- life care content in 50 textbooks from multiple specialities. JAMA 2000; 283(6): 771-8.
(21) Baverstock A, Finlay F. Specialist registrars’ emotional responses to a patient’s death. Arch Dis Child 2006; 91(9): 774-6.
(22) Mink RB, Pollack MM. Resuscitation and withdrawal of therapy in pediatric intensive care. Pediatrics 1992; 89(5): 961-3.
(23) Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 1999; 282(9): 867-74.
(24) Danis M, Federman D, Fins JJ, Fox E, Kastembaum B, Lanken PN, et al. Incorporating palliative care into critical care education: principles challenges and opportunities. Crit Care Med 1999; 27(9): 2005-13.
(25) Meert KL, Thurston CS, Thomas R. Parental coping and bereavement outcome after the death of a child in the pediatric intensive care unit. Pediatr Crit Care Med 2001; 2(4): 324-8.
(26) Devictor DJ, Nguyen DT, The Groupe Francophone de Réanimation et d´Urgences Pédiatriques. Forgoing life- sustaining treatments: how the decision is made in French pediatric intensive care units. Crit Care Med 2001; 29(7): 1356-9.
(27) Meyer EC, Burns JP, Griffith JL, Truog RD. Parenteral perspectives on end-of-life care in the pediatric intensive care unit. Crit Care Med 2002; 30(1): 226-31.
(28) Garros D, Rosychuck RJ, Cox PN. Circumstances surrounding end of life in a pediatric intensive care unit. Pediatrics 2003; 112(5): e371-8.
(29) Devictor DJ, Nguyen DT. Forgoing life-sustaining treatments in children: a comparison between Northern and Southern European pediatric intensive care units. Pediatr Crit Care Med 2004; 5(3): 211-5.
(30) World Health Organization Expert Committee. Cancer pain relief and palliate care: Report of a WHO Expert Committee. Technical Report Series 804. Geneve; WHO, 1990.
(31) Quesada L. Cuidado paliativo pediátrico. In: Gómez Sancho M., comp. Medicina paliativa en la cultura latina. Madrid: Aran, 1999: 247-89.
(32) Gherardi C. Problemática ética en el final de la vida. Segundo Curso de Introducción a la Bioética Clínica y Social. Módulo III: Temas de Bioética Clínica II. Unidad 4. [Curso online]. Disponible en: http://www.redbioetica-edu.com.ar/ [30 de setiembre de 2007].
(33) Ryan CA, Byrne P, Kuhn S, Tyebkhan, J. No resuscitation and withdrawal of therapy in a neonatal and a pediatric intensive care unit in Canada. J Pediatr 1993; 123(4): 534-8.
(34) Lantos JD, Berger AC, Zucker AR. Do-not-resuscitate orders in a children’s hospital. Crit Care Med 1993; 21(1): 52-5.
(35) Martinot A, Grandbastien B, Leteurtre S, Duhamel A, Leclerc F. Group francophone de Réanimation et d’Urgences Pédiatriques. No resuscitation orders in withdrawal of therapy in French pediatric intensive care units. Acta Paedriatr 1998; 87(7): 769-73.
(36) Ryan CA. Not resuscitation orders and withdrawal of therapy paediatric intensive care units. Acta Paediatr 1998; 87(7): 721-2.
(37) Cantegrel S, Ducrocq S, Chédeville G, Marchand S. Mortalité dans un hôspital pédiatrique : étude rétrospective sur six ans. Arch Pediatr 2000; 7(7): 725-31.
(38) American Academy of Pediatrics. Committee on Bioethics and Committee on Hospital Care. Palliative care for children. Pediatrics 2000; 106(2 Pt 1): 351-7.
(39) Roig CG. Art of communication. Pediatr Crit Care Med 2003; 4(2): 259-60.
(40) Carnevale FA, Canoui P, Cremer R, Farrell C, Doussau A, Sequin MJ. et al. Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec. Pediatr Crit Care Med 2007; 8(4): 337-42.
(41) Frader JE. Global paternalism in pediatric intensive care unit end-of-life decisons? Pediatr Crit Care Med 2003; 4(2): 257-8.
(42) Cook P, White DK, Ross-Russell RI. Bereavement support following sudden and unexpected death: guidelines for care. Arch Dis Child 2002; 87(1): 36-8.
(43) Macdonald ME, Liben S, Carnevale FA, Rennick JE, Wolf SL, Meloche D, et al. Parenteral perspectives on hospital staff members’ acts of kindness and commemoration after a child´s death. Pediatrics 2005; 116(4): 884-90.
(44) Gianantonio C. El niño con enfermedad mortal: la familia, el paciente, el pediatra. Arch Argent Pediatr 1984; 82(1): 12-6.
(2) Hynson JL, Gillis J, Collins JJ, Irving H, Trethewie SJ. The dying child: how is care different? Med J Aust 2003; 179 (6 Suppl): S20-2.
(3) Lago P, Piva J, Kipper D, et al. Limitacão de suporte de vida em três unidades de terapia intensiva pediátrica do sul do Brasil. J Pediatr (Rio J) 2005; 81(2): 111-7.
(4) Salas Arrambide M, Gabaldón Poc O, Mayoral Miravete JL, Pérez-Yarza EG, Amayra Caro. El pediatra ante la muerte del niño: integración de los cuidados paliativos en la unidad de cuidados intensivos pediátricos. An Pediatr (Barc) 2005; 62(5): 450-7.
(5) Rotta, A. Tellechea. Cuidados no final da vida em pediatria: muito mais que uma luta contra a entropia. J Pediatr (Rio J) 2005; 81(2): 93-5.
(6) Martin A. Off-season events. Child Adolesc Psychiatric Clin N Am 2006; 15(3): xiii-xv.
(7) Glazer JP, Hilden MJ, Poltorak DY. Pediatric palliative medicine. Child Adolesc Psychiatric Clin N Am 2006; 15(3): xvii-xx.
(8) Poltorak DY, Glazer JP. The development of children’s understanding of death: cognitive and psychodynamic considerations. Child Adolesc Psychiatric Clin N Am 2006; 15(3): 567-73.
(9) Bartel DA, Engler AJ, Natale JE, Misra V, Lewin AB, Joseph JG. Working with families of suddenly and critically ill children: physician experiences. Arch Pediatr Adolesc Med 2000; 154(11): 1127-34.
(10) Kipper DJ. Final de vida em crianças: aspectos técnicos e bioéticos. Porto Alegre: EDIPUCRS, 2007.
(11) Burns JP, Mitchell C, Outwater KM, Geller M, Griffith JL, Todres ID, et al. End-of-life care in the pediatric intensive care unit after the forgoing of life-sustaining treatment. Crit Care Med 2000; 28(8): 3060-6.
(12) Truog RD, Cist AF, Brackett SE, Burns JP, Curley MA, Danis M, et al. Recommendations for end-of-life care in the intensive care unit: the Ethics Committee of the Society of Critical Care Medicine. Crit Care Med 2001; 29(12): 2332-48.
(13) Althabe M, Cardigni G, Vasallo JC, Allende D, Berrueta M, et al. Dying in the intensive care unit: collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units. Pediatr Crit Care Med 2003; 4(2): 164-9.
(14) Studdert DM, Burns JP, Mello MM, Puopolo AL, Truog RD, Brennan TA. Nature of conflict in the care of pediatric intensive care patients with prolonged stay. Pediatrics 2003; 112(3 Pt 1): 553- 8.
(15) Humphry D, Wickett A. El derecho a morir: comprender la eutanasia. Barcelona: Tusquets, 1989.
(16) Morin E. El hombre y la muerte. 3 ed. Barcelona: Kairós, 1999.
(17) Ariés PH. El hombre ante la muerte. 4 ed. Madrid: Santillana, 1999.
(18) Callahan D. Living and dying with medical technology. Crit Care Med 2003; 31(5 Suppl): S344-6.
(19) Garros D. Uma boa morte em UTI pediátrica: é isso possível? J Pediatr (Rio J) 2003; 79(supl. 2): S243-54.
(20) Rabow MW, Hardie GE, Fair JM, Mcphee SJ. End-of- life care content in 50 textbooks from multiple specialities. JAMA 2000; 283(6): 771-8.
(21) Baverstock A, Finlay F. Specialist registrars’ emotional responses to a patient’s death. Arch Dis Child 2006; 91(9): 774-6.
(22) Mink RB, Pollack MM. Resuscitation and withdrawal of therapy in pediatric intensive care. Pediatrics 1992; 89(5): 961-3.
(23) Davis D, O’Brien MA, Freemantle N, Wolf FM, Mazmanian P, Taylor-Vaisey A. Impact of formal continuing medical education: do conferences, workshops, rounds and other traditional continuing education activities change physician behavior or health care outcomes? JAMA 1999; 282(9): 867-74.
(24) Danis M, Federman D, Fins JJ, Fox E, Kastembaum B, Lanken PN, et al. Incorporating palliative care into critical care education: principles challenges and opportunities. Crit Care Med 1999; 27(9): 2005-13.
(25) Meert KL, Thurston CS, Thomas R. Parental coping and bereavement outcome after the death of a child in the pediatric intensive care unit. Pediatr Crit Care Med 2001; 2(4): 324-8.
(26) Devictor DJ, Nguyen DT, The Groupe Francophone de Réanimation et d´Urgences Pédiatriques. Forgoing life- sustaining treatments: how the decision is made in French pediatric intensive care units. Crit Care Med 2001; 29(7): 1356-9.
(27) Meyer EC, Burns JP, Griffith JL, Truog RD. Parenteral perspectives on end-of-life care in the pediatric intensive care unit. Crit Care Med 2002; 30(1): 226-31.
(28) Garros D, Rosychuck RJ, Cox PN. Circumstances surrounding end of life in a pediatric intensive care unit. Pediatrics 2003; 112(5): e371-8.
(29) Devictor DJ, Nguyen DT. Forgoing life-sustaining treatments in children: a comparison between Northern and Southern European pediatric intensive care units. Pediatr Crit Care Med 2004; 5(3): 211-5.
(30) World Health Organization Expert Committee. Cancer pain relief and palliate care: Report of a WHO Expert Committee. Technical Report Series 804. Geneve; WHO, 1990.
(31) Quesada L. Cuidado paliativo pediátrico. In: Gómez Sancho M., comp. Medicina paliativa en la cultura latina. Madrid: Aran, 1999: 247-89.
(32) Gherardi C. Problemática ética en el final de la vida. Segundo Curso de Introducción a la Bioética Clínica y Social. Módulo III: Temas de Bioética Clínica II. Unidad 4. [Curso online]. Disponible en: http://www.redbioetica-edu.com.ar/ [30 de setiembre de 2007].
(33) Ryan CA, Byrne P, Kuhn S, Tyebkhan, J. No resuscitation and withdrawal of therapy in a neonatal and a pediatric intensive care unit in Canada. J Pediatr 1993; 123(4): 534-8.
(34) Lantos JD, Berger AC, Zucker AR. Do-not-resuscitate orders in a children’s hospital. Crit Care Med 1993; 21(1): 52-5.
(35) Martinot A, Grandbastien B, Leteurtre S, Duhamel A, Leclerc F. Group francophone de Réanimation et d’Urgences Pédiatriques. No resuscitation orders in withdrawal of therapy in French pediatric intensive care units. Acta Paedriatr 1998; 87(7): 769-73.
(36) Ryan CA. Not resuscitation orders and withdrawal of therapy paediatric intensive care units. Acta Paediatr 1998; 87(7): 721-2.
(37) Cantegrel S, Ducrocq S, Chédeville G, Marchand S. Mortalité dans un hôspital pédiatrique : étude rétrospective sur six ans. Arch Pediatr 2000; 7(7): 725-31.
(38) American Academy of Pediatrics. Committee on Bioethics and Committee on Hospital Care. Palliative care for children. Pediatrics 2000; 106(2 Pt 1): 351-7.
(39) Roig CG. Art of communication. Pediatr Crit Care Med 2003; 4(2): 259-60.
(40) Carnevale FA, Canoui P, Cremer R, Farrell C, Doussau A, Sequin MJ. et al. Parental involvement in treatment decisions regarding their critically ill child: a comparative study of France and Quebec. Pediatr Crit Care Med 2007; 8(4): 337-42.
(41) Frader JE. Global paternalism in pediatric intensive care unit end-of-life decisons? Pediatr Crit Care Med 2003; 4(2): 257-8.
(42) Cook P, White DK, Ross-Russell RI. Bereavement support following sudden and unexpected death: guidelines for care. Arch Dis Child 2002; 87(1): 36-8.
(43) Macdonald ME, Liben S, Carnevale FA, Rennick JE, Wolf SL, Meloche D, et al. Parenteral perspectives on hospital staff members’ acts of kindness and commemoration after a child´s death. Pediatrics 2005; 116(4): 884-90.
(44) Gianantonio C. El niño con enfermedad mortal: la familia, el paciente, el pediatra. Arch Argent Pediatr 1984; 82(1): 12-6.
Publicado
2008-03-31
Cómo citar
1.
Alberti M, Lores R, Menchaca A. Cuidados paliativos en la unidad de cuidados intensivos pediátricos. Rev. Méd. Urug. [Internet]. 31 de marzo de 2008 [citado 16 de mayo de 2024];24(1):50-5. Disponible en: http://www2.rmu.org.uy/ojsrmu311/index.php/rmu/article/view/595
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