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Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in Francophone PICUs

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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https://www.hal.inserm.fr/inserm-01371914
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Submitted on : Monday, September 26, 2016 - 3:48:36 PM
Last modification on : Saturday, April 25, 2020 - 1:35:06 AM

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Robin Cremer, Philippe Hubert, Bruno Grandbastien, Grégoire Moutel, Francis Leclerc. Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in Francophone PICUs. Intensive Care Medicine, Springer Verlag, 2011, 37 ((10)), pp.1648-55. ⟨inserm-01371914⟩

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