Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil.
Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil.
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DOI：
10.1097/01.pcc.0000154958.71041.37
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发表时间：
2005-05-01
期刊：
影响因子：
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通讯作者：
Morais, Joao Feliz Duarte
中科院分区：
文献类型：
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作者：
Kipper, Delio Jose;Piva, Jefferson Pedro;Morais, Joao Feliz Duarte
目的：研究位于巴西南部的三个儿科重症监护病房（PICU）在13年期间死亡模式、医疗决策实践和家庭参与限制生命维持治疗（L-LST）决策的可能变化。一项基于回顾性病历审查的横断面研究（1988年和1998年）和预期数据收集情况地点：巴西南部地区波尔图阿莱格雷的三个PICU。1988年、1998年、1999年5月~ 2000年5月在PICU死亡的儿童。在研究期间，3个PICU共收治了6，233名儿童，死亡率为9.2%（575例死亡），本研究评价了509份（88.5%）病历。在374例患者中确认了生命支持的全面措施（F-CPR）（73.5%）的患儿死亡前诊断为脑死亡（BD）43例（8.4%），和92生命支持治疗（L-LST）有一定局限性者占18.1%（27.5%）例患者在入院后24小时内死亡，其中128例（91.4%）接受了F-CPR，而只有11例（7.9%）患者接受了L-LST。接受F-CPR的死亡组的平均住院时间（3天）低于L-LST组（8.5天; p <0.05）。在1988年（89.1%）和1999/2000年（60.8%）之间，死亡前F-CPR率显著下降，而L-LST在此期间从6.2%上升到31.3%。这些变化在三个PICU中并不一致，L-LST的发生率不同（p <0.05）。在35.9%的案例中，家庭参与了L-LST的决策过程，从1988年的12.5%增加到1999/2000年的48.6%。在76.1%的死亡病例中记录了L-LST计划，从1988年的50.0%上升到1999/2000年的95.9%。结论：我们观察到巴西南部PICU的死亡模式在过去13年中发生了变化，L-LST增加。然而，这种变化在研究的PICU中并不一致，没有达到北方国家所描述的水平。随着时间的推移，家庭参与L-LST决策过程的情况有所增加，但仍远远落后于世界其他地区。
OBJECTIVES: To study the possible change on mode of deaths, medical decision practices, and family participation on decisions for limiting life-sustaining treatments (L-LST) over a period of 13 yrs in three pediatric intensive care units (PICUs) located in southern Brazil.METHODS: A cross-sectional study based on a retrospective chart review (1988 and 1998) and on prospective data collection (from May 1999 to May 2000).SETTING: Three PICUs in Porto Alegre, southern Brazilian region.PATIENTS: Children who died in those PICUs during the years of 1988, 1998, and between May 1999 and May 2000.RESULTS: The 3 PICUs admitted 6,233 children during the study period with a mortality rate of 9.2% (575 deaths), and 509 (88.5%) medical charts were evaluated in this study. Full measures for life support (F-CPR) were recognized in 374 (73.5%) children before dying, brain death (BD) was diagnosed in 43 (8.4%), and 92 (18.1%) underwent some limitation of life support treatment (L-LST) There were 140 (27.5%) deaths within the first 24 hrs of admission and 128 of them (91.4%) received F-CPR, whereas just 11 (7.9%) patients underwent L-LST. The average length of stay for the death group submitted to F-CPR was lower (3 days) than the L-LST group (8.5 days; p < .05). The rate of F-CPR before death decreased significantly between 1988 (89.1%) and 1999/2000 (60.8%), whereas the L-LST rose in this period from 6.2% to 31.3%. These changes were not uniform among the three PICUs, with different rates of L-LST (p < .05). The families were involved in the decision-making process for L-LST in 35.9% of the cases, increasing from 12.5% in 1988 to 48.6% in 1999/2000. The L-LST plans were recorded in the medical charts in 76.1% of the deaths, increasing from 50.0% in 1988 to 95.9% in 1999/2000.CONCLUSION: We observed that the modes of deaths in southern Brazilian PICUs changed over the last 13 yrs, with an increment in L-LST. However, this change was not uniform among the studied PICUs and did not reach the levels described in countries of the Northern Hemisphere. Family participation in the L-LST decision-making process has increased over time, but it is still far behind what is observed in other parts of the world.