Abstract
Objective: Evaluate modes of death and the treatment offered in the last 48 hours of life to patients dying in 10 Brazilian intensive care units (ICU) in a period of 2 years.
Design and setting: Cross-sectional multicenter study based on medical chart review. The medical records of all patients that died in 7 Pediatric and 3 adult ICU belonging to university and tertiary hospitals in a period of two years were included. Deaths in the first 24 hours of admission to the PICU/ICU and brain death were excluded.
Intervention: 2 fellows of each ICU were trained for filling a standard protocol (Kappa=0.9) to record demographic data and all medical management provided in the last 48 hours of life. The Student t test, Mann Whitney, chi-square and relative risk were used for data comparison.
Measurements and main Results: 1,053 medical charts were included (59.4% adult patients). Life Support Limitation (LSL) was more frequent in the adult group (86% versus 43.5%; p< 0.001). Do not resuscitate order was the most common mode LSL in both groups (75% and 66%), whereas withholding / withdrawing were more frequent in the pediatric group (33.9% versus 24.9%; p=0.02). The LSL was rarely reported in the medical chart (52.6% and 33.7%) with a scarce family involvement in the decision making process (23.0%versus 8.7%; p< 0.001).
Conclusion: LSL decision is frequent in Brazil but the most common practice is the DNR orders. The decision making process is predominantly centered on the medical perspective, with scarce participation of the family.
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Lago, P., Piva, J., Othero, J. et al. 743 Evaluating End of Life Practices in 10 Brazilian Pediatric and Adult Intensive Care Units. Pediatr Res 68 (Suppl 1), 377 (2010). https://doi.org/10.1203/00006450-201011001-00743
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DOI: https://doi.org/10.1203/00006450-201011001-00743