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. 2018 May;35(5):767-771.
doi: 10.1177/1049909117743474. Epub 2017 Nov 27.

Life-Sustaining Treatment Status at the Time of Death in a Japanese Pediatric Intensive Care Unit

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Life-Sustaining Treatment Status at the Time of Death in a Japanese Pediatric Intensive Care Unit

Fumiko Suzuki et al. Am J Hosp Palliat Care. .

Abstract

Background: Substantial variability exists among countries regarding the modes of death in pediatric intensive care units (PICUs). However, there is limited information on end-of-life care in Japanese PICUs. Thus, this study aimed to elucidate the characteristics of end-of-life care practice for children in a Japanese PICU.

Methods: We examined life-sustaining treatment (LST) status at the time of death based on medical chart reviews from 2010 to 2014. All deaths were classified into 3 groups: limitation of LST (limitation group, death after withholding or withdrawal of LST or a do not attempt resuscitation order), no limitation of LST (no-limitation group, death following failed resuscitation attempts), or brain death (brain death group).

Results: Of the 62 patients who died, 44 (71%) had limitation of LST, 18 (29%) had no limitation of LST, and none had brain death. In the limitation group, the length of PICU stay was longer than that in the no-limitation group (13.5 vs 2.5 days; P = .01). The median time to death after the decision to limit LST was 2 days (interquartile range: 1-5.5 days), and 94% of the patients were on mechanical ventilation at the time of death in the limitation group.

Conclusions: Although limiting LST was a common practice in end-of-life care in a Japanese PICU, a severe limitation of LST such as withdrawal from the ventilator was hardly practiced, and a considerable LST was still provided at the time of death.

Keywords: child death; decision-making; do not attempt resuscitation order; end-of-life care; life-sustaining treatment; pediatric intensive care unit; withdrawing treatment; withholding treatment.

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