Cremer R, Hubert P, Grandbastien B, Moutel G, Leclerc F. Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in francophone PICUs.
Intensive Care Med 2011;
37:1648-55. [PMID:
21845503 DOI:
10.1007/s00134-011-2320-3]
[Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2010] [Accepted: 04/12/2011] [Indexed: 11/26/2022]
Abstract
PURPOSE
Our goal is to assess the prevalence of questioning about the appropriateness of initiating or maintaining life-sustaining treatments (LST) in French-speaking paediatric intensive care units (PICUs) and to evaluate time utilisation related to decision-making processes (DMP).
METHODS
18-month, multicentre, prospective, descriptive, observational study in 15 French-speaking PICUs.
RESULTS
Among the 5,602 children admitted, 410 died (7.3%), including 175 after forgoing LST (42.7% of deaths). LST was questioned in 308 children (5.5%) with a prevalence of 13.3 per 100 patient-days. More than 30% of children survived despite the appropriateness of LST being questioned (23% despite a decision to forgo treatment). Median caregiver time spent on making and presenting the decisions was 11 h per child.
CONCLUSIONS
In this study, on any given day in each 10-bed PICU, there was more than one child for whom a DMP was underway. Of children, 23% survived despite a decision to forgo LST being made, which underlines the need to elaborate a care plan for these children. Also, DMP represented a large amount of staff time that is undervalued but necessary to ensure optimal palliative practice in PICU.
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