Evaluating end of life practices in ten Brazilian paediatric and adult intensive care units
| Autor: | Fernando S Dias, Pedro Celiny Ramos Garcia, Patricia Miranda do Lago, Luiz Alexandre Borges, Humberto Holmer Fiori, Jairo Othero, Renato Machado Fiori, Jefferson Pedro Piva |
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| Rok vydání: | 2010 |
| Předmět: |
Adult
Male medicine.medical_specialty Health (social science) Cross-sectional study Decision Making Psychological intervention Intensive Care Units Pediatric Life Support Care Hospitals University Arts and Humanities (miscellaneous) Intensive care medicine Humans Intensive care medicine Child Aged Retrospective Studies Terminal Care business.industry Health Policy Medical record Retrospective cohort study Length of Stay Middle Aged Issues ethics and legal aspects Intensive Care Units Cross-Sectional Studies Withholding Treatment Life support Child Preschool Emergency medicine Mann–Whitney U test Female business Brazil |
| Zdroj: | Journal of medical ethics. 36(6) |
| ISSN: | 1473-4257 |
| Popis: | To evaluate the modes of death and treatment offered in the last 24 h of life to patients dying in 10 Brazilian intensive care units (ICUs) over a period of 2 years.Cross-sectional, multicentre, retrospective study based on medical chart review. The medical records of all patients that died in seven paediatric and three adult ICUs belonging to university and tertiary hospitals over a period of 2 years were included. Deaths in the first 24 h of admission to the ICU and brain death were excluded.Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (kappa=0.9) to record demographic data and all medical management provided in the last 48 h of life. The Student t test, Mann-Whitney U test, chi(2) test and RR were used for data comparison.1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p0.001). A 'do not resuscitate' order was the most common life support limitation in both groups (75% and 66%), whereas withholding/withdrawing were more frequent in the paediatric group (33.9% vs 24.9%; p=0.02). The life support limitation was rarely reported in the medical chart in both groups (52.6% and 33.7%) with scarce family involvement in the decision making process (23.0% vs 8.7%; p0.001).Life support limitation decision making in Brazilian ICUs is predominantly centred on the medical perspective with scarce participation of the family, and consequently several non-coherent medical interventions are observed in patients with life support limitation. |
| Databáze: | OpenAIRE |
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