Skip to main content

Advertisement

Log in

Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment

  • Pediatric Original
  • Published:
Intensive Care Medicine Aims and scope Submit manuscript

Abstract

Background

The mortality for children with prolonged stay in pediatric intensive care units (PICU) is much higher than overall mortality. The incidence of withdrawal or limitation of therapy in this group is unknown.

Purpose

To assess mortality and characteristics of children admitted for ≥28 days to our ICU, and to describe the extent to which limitations of care were involved in the terminal phase preceding death.

Methods

For the period 2003 to 2005 clinical data were collected retrospectively for children with prolonged stay (defined as ≥28 days) in a medical/surgical PICU of a university children’s hospital.

Results

In the PICU, 4.4% of the children (116/2,607, equal gender, mean age 29 days) had a prolonged stay. Median (range) stay was 56 (28–546) days. These children accounted for 3% of total admissions and occupied 63% of total admission days. Mortality during admission for this group was five times higher (22%) than the average PICU mortality rate of 4.6%. Withdrawal or limitation of therapy preceded 70% of deaths.

Conclusions

Children with prolonged stay in the PICU have a significantly high risk of mortality. Death is typically preceded by limitation of care.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

Abbreviations

LSP:

Long-stay patient

PICU:

Pediatric intensive care unit

References

  1. Marcin JP, Slonim AD, Pollack MM, Ruttimann UE (2001) Long-stay patients in the pediatric intensive care unit. Crit Care Med 29:652–657

    Article  CAS  PubMed  Google Scholar 

  2. Slonim AD, Marcin JP, Pollack MM (2003) Long-stay patients: are there any long-term solutions? Crit Care Med 31:313–314

    Article  PubMed  Google Scholar 

  3. Pollack MM, Wilkinson JD, Glass NL (1987) Long-stay pediatric intensive care unit patients: outcome and resource utilization. Pediatrics 80:855–860

    CAS  PubMed  Google Scholar 

  4. Gemke RJ, Bonsel GJ (1995) Comparative assessment of pediatric intensive care: a national multicenter study. Pediatric Intensive Care Assessment of Outcome (PICASSO) Study Group. Crit Care Med 23:238–245

    Article  CAS  PubMed  Google Scholar 

  5. Ruttimann UE, Pollack MM (1996) Variability in duration of stay in pediatric intensive care units: a multiinstitutional study. J Pediatr 128:35–44

    Article  CAS  PubMed  Google Scholar 

  6. van der Heide P, Hassing MB, Gemke RJ (2004) Characteristics and outcome of long-stay patients in a paediatric intensive care unit: a case–control study. Acta Paediatr 93:1070–1074

    Article  PubMed  Google Scholar 

  7. Friedrich JO, Wilson G, Chant C (2006) Long-term outcomes and clinical predictors of hospital mortality in very long stay intensive care unit patients: a cohort study. Crit Care 10:R59

    Article  PubMed  Google Scholar 

  8. Tibballs J (2007) Legal basis for ethical withholding and withdrawing life-sustaining medical treatment from infants and children. J Paediatr Child Health 43:230–236

    Article  PubMed  Google Scholar 

  9. Kanter RK, Bove EL, Tobin JR, Zimmerman JJ (1986) Prolonged mechanical ventilation of infants after open heart surgery. Crit Care Med 14:211–214

    Article  CAS  PubMed  Google Scholar 

  10. Gemke RJ, Bonsel GJ, van Vught AJ (1995) Long-term survival and state of health after paediatric intensive care. Arch Dis Child 73:196–201

    Article  CAS  PubMed  Google Scholar 

  11. Levetown M, Pollack MM, Cuerdon TT, Ruttimann UE, Glover JJ (1994) Limitations and withdrawals of medical intervention in pediatric critical care. JAMA 272:1271–1275

    Article  CAS  PubMed  Google Scholar 

  12. Hazebroek FW, Tibboel D, Mourik M, Bos AP, Molenaar JC (1993) Withholding and withdrawal of life support from surgical neonates with life-threatening congenital anomalies. J Pediatr Surg 28:1093–1097

    Article  CAS  PubMed  Google Scholar 

  13. Garros D, Rosychuk RJ, Cox PN (2003) Circumstances surrounding end of life in a pediatric intensive care unit. Pediatrics 112:e371

    Article  PubMed  Google Scholar 

  14. Gill M (2005) PICU prometheus: ethical issues in the treatment of very sick children in pediatric intensive care. Mortality 10:262–275

    Article  Google Scholar 

  15. Verhagen AA, Sauer PJ (2005) End-of-life decisions in newborns: an approach from The Netherlands. Pediatrics 116:736–739

    Article  CAS  PubMed  Google Scholar 

  16. Mink RB, Pollack MM (1992) Resuscitation and withdrawal of therapy in pediatric intensive care. Pediatrics 89:961–963

    CAS  Google Scholar 

  17. Parker BL, Frewen TC, Levin SD, Ramsay DA, Young GB, Reid RH, Singh NC, Gillett JM (1995) Declaring pediatric brain death: current practice in a Canadian pediatric critical care unit. CMAJ 153:909–916

    CAS  PubMed  Google Scholar 

  18. Guidelines for the appropriate use of do-not-resuscitate orders (1991) Council on Ethical and Judicial Affairs, American Medical Association. JAMA 265:1868–1871

    Article  Google Scholar 

  19. Guidelines for the diagnosis of brain death. Patient Care Policy (1987) Toronto, Ontario, Canada; Hospital for Sick Children (Report No. 2.25)

  20. Do not resuscitate (DNR) order (1994) In: Policy and Procedure Manual Hospital for Sick Children. Toronto, Ontario, Canada. 1–3

  21. Hazebroek FW, Bouman NH, Tibboel D (2001) The neonate with major malformations: experiences in a university children’s hospital in the Netherlands. Semin Pediatr Surg 10:222–229

    Article  CAS  PubMed  Google Scholar 

  22. Caniano DA, Hazebroek FW, DenBesten KE, Tibboel D (1995) End-of-life decisions for surgical neonates: experience in The Netherlands and United States. J Pediatr Surg 30:1420–1424

    Article  CAS  PubMed  Google Scholar 

  23. Rimachi R, Vincent JL, Brimioulle S (2007) Survival and quality of life after prolonged intensive care unit stay. Anaesth Intensive Care 35:62–67

    CAS  PubMed  Google Scholar 

  24. Gracey DR, Naessens JM, Krishan I, Marsh HM (1992) Hospital and posthospital survival in patients mechanically ventilated for more than 29 days. Chest 101:211–214

    Article  CAS  PubMed  Google Scholar 

  25. Montuclard L, Garrouste-Orgeas M, Timsit JF, Misset B, De Jonghe B, Carlet J (2000) Outcome, functional autonomy, and quality of life of elderly patients with a long-term intensive care unit stay. Crit Care Med 28:3389–3395

    Article  CAS  PubMed  Google Scholar 

  26. O’Brien BP, Butt W, Suhr H, Bimpeh Y, McKenna AM, Bailey MJ, Scheinkestel CD (2006) The functional outcome of patients requiring over 28 days of intensive care: a long-term follow-up study. Crit Care Resusc 8:200–204

    PubMed  Google Scholar 

  27. Hughes M, MacKirdy FN, Norrie J, Grant IS (2001) Outcome of long-stay intensive care patients. Intensive Care Med 27:779–782

    Article  CAS  PubMed  Google Scholar 

  28. Verhagen E, Sauer PJ (2005) The Groningen protocol-euthanasia in severely ill newborns. N Engl J Med 352:959–962

    Article  CAS  PubMed  Google Scholar 

  29. Bondi SA, Gries D, Faucette K (2006) Neonatal euthanasia? Pediatrics 117:983–984

    Article  PubMed  Google Scholar 

Download references

Conflict of interest statement

None.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Dick Tibboel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Naghib, S., van der Starre, C., Gischler, S.J. et al. Mortality in very long-stay pediatric intensive care unit patients and incidence of withdrawal of treatment. Intensive Care Med 36, 131–136 (2010). https://doi.org/10.1007/s00134-009-1693-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00134-009-1693-z

Keywords

Navigation