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Title: End-of-life care in a pediatric intensive care unit: the impact of the development of a palliative care unit
Author: Bobillo Pérez, Sara
Segura Matute, Susana
Girona Alarcón, Mònica
Felipe Villalobos, Aida
Balaguer Gargallo, Mònica
Hernández Platero, Lluisa
Solé Ribalta, Anna
Guitart, Carmina
Jordán García, Iolanda
Cambra Lasaosa, Francisco José
Keywords: Pediatria intensiva
Tractament pal·liatiu
Mortalitat infantil
Pediatric intensive care
Palliative treatment
Infant mortality
Issue Date: 28-May-2020
Publisher: BioMed Central
Abstract: Background: The purpose of this paper is to describe how end-of-life care is managed when life-support limitationis decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit. Methods: A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records. Results: One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding lifesustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn. Conclusions: The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care.
Note: Reproducció del document publicat a:
It is part of: BMC Palliative Care, 2020, vol. 19, num. 74
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ISSN: 1472-684X
Appears in Collections:Articles publicats en revistes (Cirurgia i Especialitats Medicoquirúrgiques)

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