Abstract
We have conducted a retrospective study of deaths on a paediatric medical intensive care unit over a two-year period and reviewed similar series from outside the UK. There were 89 deaths out of 651 admission (13.7% mortality). In almost two-thirds of the cases death occurred with a decision to limit medical treatment or withdraw mechanical ventilation, implying that additional or further therapy was considered futile. We highlight this as a crucially important issue in the practice of intensive care. More comprehensive studies are needed to help clinicians derive consensus on what constitutes a futile intervention, and therefore when such an intervention should be withheld. This will help families and society better understand the limitations of intensive care.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Dyer Clare. Appeal Court supports doctors' decision not to treat. BMJ. 1992 Jun 13;304(6841):1527–1528. [PMC free article] [PubMed] [Google Scholar]
- Lantos J. D., Berger A. C., Zucker A. R. Do-not-resuscitate orders in a children's hospital. Crit Care Med. 1993 Jan;21(1):52–55. doi: 10.1097/00003246-199301000-00012. [DOI] [PubMed] [Google Scholar]
- Mink R. B., Pollack M. M. Resuscitation and withdrawal of therapy in pediatric intensive care. Pediatrics. 1992 May;89(5 Pt 1):961–963. [PubMed] [Google Scholar]
- Ryan C. A., 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 Oct;123(4):534–538. doi: 10.1016/s0022-3476(05)80946-1. [DOI] [PubMed] [Google Scholar]
- Schneiderman L. J., Jecker N. S., Jonsen A. R. Medical futility: its meaning and ethical implications. Ann Intern Med. 1990 Jun 15;112(12):949–954. doi: 10.7326/0003-4819-112-12-949. [DOI] [PubMed] [Google Scholar]
- Tomlinson T., Brody H. Futility and the ethics of resuscitation. JAMA. 1990 Sep 12;264(10):1276–1280. [PubMed] [Google Scholar]
- Vernon D. D., Dean J. M., Timmons O. D., Banner W., Jr, Allen-Webb E. M. Modes of death in the pediatric intensive care unit: withdrawal and limitation of supportive care. Crit Care Med. 1993 Nov;21(11):1798–1802. doi: 10.1097/00003246-199311000-00035. [DOI] [PubMed] [Google Scholar]