Modes of death in the pediatric intensive care unit: Withdrawal and limitation of supportive care

OBJECTIVE:To determine the frequency of withdrawal or limitation of supportive care for children dying in a pediatric intensive care unit (ICU). DESIGN:Retrospective review of medical records. SETTING:Pediatric ICU in a tertiary care childrenʼs hospital. PATIENTS:All children dying in the pediatric ICU over a 54-month period (n = 300). INTERVENTIONS:Medical record review. MEASUREMENTS AND MAIN RESULTS:Data recorded for each patient included diagnosis, mode of death, and whether the child was brain dead. Each patient was assigned to one of the following mode of death categoriesbrain dead; active withdrawal of supportive care (meaning removal of the endotracheal tube); failed cardiopulmonary resuscitation; allowed to die without cardiopulmonary resuscitation (do-not-resuscitate status). A total of 300 patients were identified. Diagnoses included postoperative congenital heart disease (n = 56), head trauma (n = 38), near-miss sudden infant death syndrome (n = 28), pneumonia (n = 22), sepsis (n = 21), near-drowning (n = 21), various anoxic insults (n = 20), multiple trauma (n = 17), and patients with other diagnoses (n = 77). Mode of death was active discontinuation of support in 95 (32%) patients, do-not-resuscitate status in 78 (26%), brain death in 70 (23%), and failed cardiopulmonary resuscitation in 57 (19%). CONCLUSIONS:In a large, multidisciplinary pediatric ICU, the most common mode of death was active withdrawal of support. In addition, more than half (173/300, 58%) of children dying in the pediatric ICU underwent either active withdrawal or limitation (do-not-resuscitate status) of supportive care. (Crit Care Med 1993; 21:1798–1802)