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Titolo:
End-of-life care in the pediatric intensive cave unit after the forgoing of life-sustaining treatment
Autore:
Burns, JP; Mitchell, C; Outwater, KM; Geller, M; Griffith, JL; Todres, ID; Truog, RD;
Indirizzi:
Harvard Univ, Sch Med, Dept Anesthesia, Boston, MA 02115 USA Harvard UnivBoston MA USA 02115 d, Dept Anesthesia, Boston, MA 02115 USA Childrens Hosp, Off Eth, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 ns Hosp, Off Eth, Boston, MA 02115 USA Childrens Hosp, Dept Patient Care Serv, Boston, MA 02115 USA Childrens Hosp Boston MA USA 02115 atient Care Serv, Boston, MA 02115 USA Massachusetts Gen Hosp, Dept Pediat, Boston, MA 02114 USA Massachusetts Gen Hosp Boston MA USA 02114 t Pediat, Boston, MA 02114 USA New England Med Ctr, Biostat Res Ctr, Boston, MA 02111 USA New England MedCtr Boston MA USA 02111 tat Res Ctr, Boston, MA 02111 USA St Lukes Hosp, Dept Pediat, Saginaw, MI USA St Lukes Hosp Saginaw MI USASt Lukes Hosp, Dept Pediat, Saginaw, MI USA
Titolo Testata:
CRITICAL CARE MEDICINE
fascicolo: 8, volume: 28, anno: 2000,
pagine: 3060 - 3066
SICI:
0090-3493(200008)28:8<3060:ECITPI>2.0.ZU;2-B
Fonte:
ISI
Lingua:
ENG
Soggetto:
RESPIRATORY-DISTRESS SYNDROME; PHYSICIAN-ASSISTED SUICIDE; CRITICALLY ILL PATIENTS; MECHANICAL VENTILATION; CONSTITUTIONAL RIGHT; CLINICAL MANAGEMENT; SLOW EUTHANASIA; TERMINALLY ILL; SUPREME-COURT; VECURONIUM;
Keywords:
critical illness; therapy; decision making; life-support care; physician-patient relations; terminal care; statistics; numerical data;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
62
Recensione:
Indirizzi per estratti:
Indirizzo: Burns, JP Harvard Univ, Sch Med, Dept Anesthesia, Boston, MA 02115 USA Harvard Univ Boston MA USA 02115 esthesia, Boston, MA 02115 USA
Citazione:
J.P. Burns et al., "End-of-life care in the pediatric intensive cave unit after the forgoing of life-sustaining treatment", CRIT CARE M, 28(8), 2000, pp. 3060-3066

Abstract

Objective: To describe the attitudes and practice of clinicians in providing sedation and analgesia to dying patients as life-sustaining treatment iswithdrawn. Study Design: Prospective case series of 53 consecutive patients who died after the withdrawal of life-sustaining treatment in the pediatric intensive care unit at three teaching hospitals in Boston. Data on the reasons why medications were given were obtained from a self-administered anonymous questionnaire completed by the critical care physician and nurse for each case. Data on what medications were given were obtained from a review of the medical record. Results: Sedatives and/or analgesics were administered to 47 (89%) patients who died after the withdrawal of life-sustaining treatment. Patients who were comatose were less likely to receive these medications. Physicians andnurses cited treatment of pain, anxiety, and air hunger as the most commonreasons, and hastening death as the least common reason, for administration of these medications. Hastening death was viewed as an "acceptable, unintended side effect" of terminal care by 91% of physician-nurse matched pairs. The mean dose of sedatives and analgesics administered nearly doubled as life-support was withdrawn, and the degree of escalation in dose did not correlate with clinician's views on hastening death. Conclusion: Clinicians frequently escalate the dose of sedatives or analgesics to dying patients as life-sustaining treatment is withdrawn, citing patient-centered reasons as their principle justification. Hastening death isseen as an unintended consequence of appropriate care, A large majority ofphysicians and nurses agreed with patient management and were satisfied with the care provided. Care of the dying patient after the forgoing of life-sustaining treatment remains underanalyzed and needs more rigorous examination by the critical care community.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 03/04/20 alle ore 20:14:58