Ways of dying in the Children's Intensive Care Unit of the Pediatric Hospital of the Pereira Rossell Hospital Center
Abstract
Introduction: studying the modes of death in children hospitalized in the pediatric intensive care unit is essential for the ethical handling of application and limitation of technology.
Objective: to describe the modes of death and factors leading to withdrawal or limitation of life support in a pediatric intensive care unit and to contribute to the selection of a more humane end-of-life process.
Method: we conducted a prospective observational study which included infants dying from January 1, 2005 to June 30, 2007. Deaths were classified into four categories: ineffective cardiopulmonary resuscitation (CPR), no cardiopulmonary resuscitation (CPR), limitation or withdrawal of life support and brain death.
We applied a chi-square test of qualitative variables, analysis of variance of quantitative variables and polynomial logistics regression.
Results: 129 cases. The modes of death proportion was: CPR- 51%; no CPR - 12%; limitation or withdrawal of life support - 15.5% and brain death - 21%. Age, length of stay and chronic disease were significant factors that influenced the modes of death. Family members participated in 76% of the decisions made. As to the limitation of life support modality, in 75% of cases it was interrupted and in 20 % of cases it was not initiated.
Conclusions: Most patients received cardiopulmonary resuscitation. Age, length of stay and chronic disease had a significant influence on the modes of death. Upon the limitation of therapeutic efforts, the length of stay was longer, as well as in the case of chronic disease. Withdrawal of treatment prevailed over noninitiation of life support. The participation of family members in making a life or death decision was high.
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