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Evaluating end of life practices in ten Brazilian paediatric and adult intensive care units
  1. Jefferson Piva1,2,3,
  2. Patrícia Lago4,
  3. Jairo Othero5,
  4. Pedro Celiny Garcia6,
  5. Renato Fiori7,
  6. Humberto Fiori7,
  7. Luiz Alexandre Borges8,
  8. Fernando S Dias9
  1. 1School of Medicine, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Brazil
  2. 2School of Medicine, Universidade Federal do RS (UFRGS), Brazil
  3. 3Pediatric Intensive Care Unit, Sao Lucas Hospital, PUCRS University, Brazil
  4. 4Pediatric Intensive Care Unit, Clinicas Hospital, UFRGS University, Brazil
  5. 5Intensive Care Unit, Luterano Hospital, ULBRA University, Brazil
  6. 6School of Medicine, PUCRS University, Pediatric Intensive Care Unit, Sao Lucas Hospital, PUCRS University, Brazil
  7. 7School of Medicine, PUCRS University, Neonatal Intensive Care Unit, Sao Lucas Hospital, PUCRS University, Brazil
  8. 8Intensive Care Unit, Conceiçao Hospital, Porto Alegre, Brazil
  9. 9School of Medicine, PUCRS University, Director of the Intensive Care Unit at Sao Lucas Hospital, PUCRS University, Brazil
  1. Correspondence to Dr Jefferson P Piva, Pediatric Intensive Care, Unit H, São Lucas-PUCRS, Av. Ipiranga 6690 – 5 andar, CEP – 90.610-000, Porto Alegre (RS), Brazil; jpiva{at}terra.com.br

Abstract

Objective 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.

Design and setting 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.

Intervention Two intensive care fellows of each ICU were trained in fulfilling a standard protocol (κ=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, χ2 test and RR were used for data comparison.

Measurements and main results 1053 medical charts were included (59.4% adult patients). Life support limitation was more frequent in the adult group (86% vs 43.5%; p<0.001). 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%; p<0.001).

Conclusion 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.

  • End of life
  • life support limitation
  • death
  • palliative care
  • cardiopulmonary resuscitation
  • attitudes towards death
  • care of the dying patient

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Footnotes

  • Funding This study had financial support from the Brazilian National Research Council (CNPq # 054/2005).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of the all the institutions involved.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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