[Modes of dying of children in Intensive Care Units in Spain: MOMUCIP study]

Abstract

Objective: To describe the different types of child deaths in Paediatric Intensive Care Units (PICU) in Spain, and to analyse the characteristics of those dying from a limitation of therapeutic efforts (LET).

Method: A multicentre retrospective study by conducted by reviewing the hospital discharge reports corresponding to deceased patients in 8 Spanish PICUs between 2011 and 2017.

Results: A total of 337 deaths were recorded, of which 151 (50'7%) occurred after a decision of LET, while 114 (33'8%) were due to an indicated, but failed, cardiopulmonary resuscitation, and 52 (15.4%) were due to brain death. The most common causes of hospital admission for those children that finally died were a heart-related problem (32.6%) or a respiratory problem (22.6%). A total of 86 cases (25.5%) had a previous hospital admission, with 253 cases (75%) suffering from some type of chronical illness, and 78 (23%) had a serious disability at the time of the admission. LET cases were more frequent among these children and those suffering from cancer. The predominant LET type consisted in: not starting the CPR in the event of a cardiac arrest (45%), withdrawal of the respiratory support (31.6%), and withdrawal of vasoactive drugs (21.6%).

Conclusions: At the present time, at least half of the children dying in a PICU in Spain die after a LET decision, which is more frequent in those patients with previous hospital admissions, with a serious incapacity, and chronic or oncological disease. Health professionals should be aware of this situation, and be prepared to share decisions with the families, and to offer children at the end of their life the best possible caring quality.

Keywords: Adecuación del esfuerzo terapéutico; Adequate therapeutic effort; Children; Cuidados intensivos; Death; Donación; Ethics; Intensive care; Limitación de tratamientos de soporte vital; Limitación del esfuerzo terapéutico; Limitation of life-support treatments; Limitation of therapeutic effort; Muerte; Necropsia; Necropsy; Niños; Organ donation; Organ transplantation; Trasplante; Ética.