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VOLUME 19 , ISSUE 3 ( 2015 ) > List of Articles

RESEARCH ARTICLE

Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country

Naveed-ur-Rehman Siddiqui, Zohaib Ashraf, Humaira Jurair, Anwarul Haque

Keywords : Brain death, death, do-not-resuscitate, end-of-life care, failed cardiopulmonary resuscitation, Pediatric Intensive Care Unit, withdrawal of care

Citation Information : Siddiqui N, Ashraf Z, Jurair H, Haque A. Mortality patterns among critically ill children in a Pediatric Intensive Care Unit of a developing country. Indian J Crit Care Med 2015; 19 (3):147-150.

DOI: 10.4103/0972-5229.152756

License: CC BY-ND 3.0

Published Online: 00-03-2015

Copyright Statement:  Copyright © 2015; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background and Aim: Advances in biomedical technology have made medical treatment to be continued beyond a point, at which it does not confer an advantage but may increase the suffering of patients. In such cases, continuation of care may not always be useful, and this has given rise to the concept of limitation of life-sustaining treatment. Our aim was to study mortality patterns over a 6-year period in a Pediatric Intensive Care Unit (PICU) in a developing country and to compare the results with published data from other countries. Materials a nd Methods: Retrospective cohort study was conducted in a PICU of a tertiary care hospital in Pakistan. Data were drawn from the medical records of children aged 1-month - 16 years of age who died in PICU, from January 2007 to December 2012. Results: A total of 248 (from an admitted number of 1919) patients died over a period of 6 years with a mortality rate 12.9%. The median age of children who died was 2.8 years, of which 60.5% (n = 150) were males. The most common source of admission was from the emergency room (57.5%, n = 143). The most common cause of death was limitation of life-sustaining treatment (63.7%, n = 158) followed by failed cardiopulmonary resuscitation (28.2%, n = 70) and brain death (8.1%, n = 20). We also found an increasing trend of limitation of life-sustaining treatment do-not-resuscitate (DNR) over the 6-year reporting period. Conclusion: We found limitation of life support treatment (DNR + Withdrawal of Life support Treatment) to be the most common cause of death, and parents were always involved in the end-of-life care decision-making.


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  1. Devictor D, Latour JM, Tissières P. Forgoing life-sustaining or death-prolonging therapy in the pediatric ICU. Pediatr Clin North Am 2008;55:791-804, xiii.
  2. Moore P, Kerridge I, Gillis J, Jacobe S, Isaacs D. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature. J Paediatr Child Health 2008;44:404-8.
  3. Ryan CA, Byrne P, Kuhn S, Tyebkhan J. No resuscitation and withdrawal of therapy in a neonatal and a pediatric intensive care unit in Canada. J Pediatr 1993;123:534-8.
  4. Lago PM, Piva J, Kipper D, Garcia PC, Pretto C, Giongo M, et al. Life support limitation at three pediatric intensive care units in southern Brazil. J Pediatr (Rio J) 2005;81:111-7.
  5. Vernon DD, Dean JM, Timmons OD, Banner W Jr, Allen-Webb EM. Modes of death in the pediatric intensive care unit: Withdrawal and limitation of supportive care. Crit Care Med 1993;21:1798-802.
  6. ten Berge J, de Gast-Bakker DA, Plötz FB. Circumstances surrounding dying in the paediatric intensive care unit. BMC Pediatr 2006;6:22.
  7. van der Wal ME, Renfurm LN, van Vught AJ, Gemke RJ. Circumstances of dying in hospitalized children. Eur J Pediatr 1999;158:560-5.
  8. Devictor DJ, Nguyen DT. Forgoing life-sustaining treatments in children: A comparison between Northern and Southern European pediatric intensive care units. Pediatr Crit Care Med 2004;5:211-5.
  9. Lantos JD, Berger AC, Zucker AR. Do-not-resuscitate orders in a children′s hospital. Crit Care Med 1993;21:52-5.
  10. Mani RK. End-of-life care in India. Intensive Care Med 2006;32:1066-8.
  11. Mani RK. Limitation of life support in the ICU. Ethical issues relating to end of life care. Indian J Crit Care Med 2003;7:112-7.
  12. Kapadia F, Singh M, Divatia J, Vaidyanathan P, Udwadia FE, Raisinghaney SJ, et al. Limitation and withdrawal of intensive therapy at the end of life:Practices in intensive care units in Mumbai, India. Crit Care Med 2005;33:1272-5.
  13. Robabeh G, Rafeey M. Prediction of mortality circumstances in the pediatric intensive care unit. Res J Biol Sci 2008;3:1034-6.
  14. Chehab M. Modes of death in a pediatric intensive care unit in the Muslim community of Saudi Arabia. Clin Intensive Care 2003;14:135-9.
  15. Yaguchi A, Truog RD, Curtis JR, Luce JM, Levy MM, Mélot C, et al. International differences in end-of-life attitudes in the intensive care unit: Results of a survey. Arch Intern Med 2005;165:1970-5.
  16. Miccinesi G, Fischer S, Paci E, Onwuteaka-Philipsen BD, Cartwright C, van der Heide A, et al. Physicians′ attitudes towards end-of-life decisions: A comparison between seven countries. Soc Sci Med 2005;60:1961-74.
  17. Vincent JL. Forgoing life support in western European intensive care units: The results of an ethical questionnaire. Crit Care Med 1999;27:1626-33.
  18. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European intensive care units: The Ethicus Study. JAMA 2003;290:790-7.
  19. Young RJ, King A. Legal aspects of withdrawal of therapy. Anaesth Intensive Care 2003;31:501-8.
  20. Haque A, Ladak LA, Hamid MH, Mirza S, Siddiqui NR, Bhutta ZA. A national survey of pediatric intensive care units in Pakistan. J Crit Care Med 2014;2014:1-4.
  21. Mink RB, Pollack MM. Resuscitation and withdrawal of therapy in pediatric intensive care. Pediatrics 1992;89:961-3.
  22. Zawistowski CA, DeVita MA. A descriptive study of children dying in the pediatric intensive care unit after withdrawal of life-sustaining treatment. Pediatr Crit Care Med 2004;5:216-23.
  23. Garros D, Rosychuk RJ, Cox PN. Circumstances surrounding end of life in a pediatric intensive care unit. Pediatrics 2003;112:e371.
  24. Sands R, Manning JC, Vyas H, Rashid A. Characteristics of deaths in paediatric intensive care: A 10-year study. Nurs Crit Care 2009;14:235-40.
  25. Balfour-Lynn IM, Tasker RC. At the coalface - Medical ethics in practice. Futility and death in paediatric medical intensive care. J Med Ethics 1996;22:279-81.
  26. Ramnarayan P, Craig F, Petros A, Pierce C. Characteristics of deaths occurring in hospitalised children: Changing trends. J Med Ethics 2007;33:255-60.
  27. Martinot A, Grandbastien B, Leteurtre S, Duhamel A, Leclerc F. No resuscitation orders and withdrawal of therapy in French paediatric intensive care units. Groupe Francophone de Réanimation et d′Urgences Pédiatriques. Acta Paediatr 1998;87:769-73.
  28. Goh AY, Mok Q. Identifying futility in a paediatric critical care setting: A prospective observational study. Arch Dis Child 2001;84:265-8.
  29. Devictor DJ, Nguyen DT, Groupe Francophone de Réanimation et d′Urgences Pédiatriques. Forgoing life-sustaining treatments: How the decision is made in French pediatric intensive care units. Crit Care Med 2001;29:1356-9.
  30. Althabe M, Cardigni G, Vassallo JC, Allende D, Berrueta M, Codermatz M, et al. Dying in the intensive care unit: Collaborative multicenter study about forgoing life-sustaining treatment in Argentine pediatric intensive care units. Pediatr Crit Care Med 2003;4:164-9.
  31. Kipper DJ, Piva JP, Garcia PC, Einloft PR, Bruno F, Lago P, et al. Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil. Pediatr Crit Care Med 2005;6:258-63.
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