Withdrawal and limitation of life support in paediatric intensive care
Paediatric Intensive
Care Unit, University Malaya Medical Centre, 50603 Kuala Lumpur,
Malaysia
Correspondence to: Dr Goh.
Accepted 6
January 1999
OBJECTIVES
To compare
the modes of death and factors leading to withdrawal or limitation of
life support in a paediatric intensive care unit (PICU) in a developing country.
METHODSRetrospective
analysis of all children (< 12 years) dying in the PICU from January
1995 to December 1995 and January 1997 to June 1998 (n = 148).
RESULTSThe main mode
of death was by limitation of treatment in 68 of 148 patients, failure
of active treatment including cardiopulmonary resuscitation in 61, brain death in 12, and withdrawal of life support with removal of
endotracheal tube in seven. There was no significant variation in the
proportion of limitation of treatment, failure of active treatment, and
brain death between the two periods; however, there was an increase in
withdrawal of life support from 0% in 1995 to 8% in 1997-98.
Justification for limitation was based predominantly on expectation of
imminent death (71 of 75). Ethnic variability was noted among the 14 of
21 patients who refused withdrawal. Discussions for care restrictions
were initiated almost exclusively by paediatricians (70 of 75).
Diagnostic uncertainty (36% v 4.6%) and
presentation as an acute illness were associated with the use of active treatment.
CONCLUSIONSLimitation
of treatment is the most common mode of death in a developing
country's PICU and active withdrawal is still not widely practised.
Paediatricians in developing countries are becoming more proactive in
managing death and dying but have to consider sociocultural and
religious factors when making such decisions.
Keywords: limitation of life support; intensive care; cross cultural ethical issues
© 1999 by Archives of Disease in Childhood
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