Summary of the phases of care in relation to withdrawal of life-sustaining ventilation out of the paediatric intensive care unit2–4
| Phase of care | Child/family | Environment/staff |
|---|---|---|
| Introduction of withdrawal and preparation | Discuss parallel planning and potential outcomes Family choices (place/time) Personal resuscitation plans Anticipatory management of symptom control Faith and spiritual needs | Joint planning between teams Advanced care plan for child Consult with palliative care service Equipment/medications required Transport/staff Organ donation/autopsy |
| Pre-transfer | Contact numbers End-of-life care plan confirmation Rationalisation of medication Discuss time frame for extubation Agree symptom management plan | Place of care/practicalities Establish team roles Contact appropriate local services Diagnosis/certification/coroner |
| Extubation | Provide time for privacy and rituals Discuss possible symptoms and management | Consider pre-emptive symptom management |
| Postextubation | Contact details of leading team Symptom management Communication | Constant symptom review Plan ongoing fluid management Ensure ongoing care provision (24 hours telephone support) |
| Postdeath | Faith and spiritual needs accommodated Registration of death Funeral care arrangements On-going bereavement support | Verification Medical certification Child death overview panel Ensure adequate bereavement support Establish place of care of body |