TY - JOUR T1 - Evaluating end of life practices in ten Brazilian paediatric and adult intensive care units JF - Journal of Medical Ethics JO - J Med Ethics SP - 344 LP - 348 DO - 10.1136/jme.2009.035113 VL - 36 IS - 6 AU - Jefferson Piva AU - Patrícia Lago AU - Jairo Othero AU - Pedro Celiny Garcia AU - Renato Fiori AU - Humberto Fiori AU - Luiz Alexandre Borges AU - Fernando S Dias Y1 - 2010/06/01 UR - http://jme.bmj.com/content/36/6/344.abstract N2 - 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. ER -