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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Alterations in end-of-life support in the pediatric intensive care unit.
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Alterations in end-of-life support in the pediatric intensive care unit.

机译：儿科重症监护病房寿命终止支持的变更。

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OBJECTIVE: Our purpose was to examine alterations in end-of-life support in a multiinstitutional sample of PICUs. METHODS: This was a retrospective, descriptive study. Variables collected included end-of-life support category, race, length of stay, operative status, reason for admission, and Pediatric Index of Mortality 2 score, as well as the number of ICU beds and the presence of trainees. RESULTS: There were 1745 deaths at 35 institutions between January 1, 2004, and September 30, 2005. Of those, 1263 had complete data and were analyzed. The end-of-life support category distribution was as follows: brain death, 296 (23%); do not resuscitate, 205 (16%); limitation of support, 36 (3%); withdrawal of support, 579 (46%); no limitation, 124 (10%); no advance directives, 23 (2%). For further analyses, end-of-life support categories were grouped as limitation (ie, do not resuscitate, limitation of support, or withdrawal of support) versus no limitation (ie, no limitation or no advance directive). Brain death was not included in further analyses. The majority of deaths were in the limitation group (n=820 [85%]), and 12 (40%) of 30 institutions had 100% of deaths in this group. There were significant differences between institutions (P<.001). Decisions for limitation were seen less frequently in the black race (112 [76%] of 147 deaths; P=.037) and in institutions with no trainees (56 [69%] of 81 deaths; P<.001). CONCLUSIONS: Decisions to limit support are common. Black race and an absence of trainees are associated with decreased frequency of limitation decisions.
机译：目的：我们的目的是检查PICUs多机构样本中生命终止支持的改变。方法：这是一项回顾性描述性研究。收集的变量包括生命支持类别，种族，住院时间，手术状态，入院原因和小儿死亡率指数2得分，以及ICU床位数和受训者的人数。结果：2004年1月1日至2005年9月30日之间，有35家机构死亡1745人。其中有1263人拥有完整的数据并进行了分析。生命终止支持类别分布如下：脑死亡296（23％）;不复苏，205（16％）;支持上限，36（3％）;撤回支持，579（46％）;无限制124（10％）;没有预先指示，23（2％）。为了进一步分析，将寿命终止支持类别分为限制（即，不复苏，限制或退出支持）与不限制（即，不限制或没有预先指示）。脑死亡不包括在进一步的分析中。死亡的大多数在限制组中（n = 820 [85％]），30个机构中有12个（40％）在该组中有100％的死亡。机构之间存在显着差异（P <.001）。在黑人种族（147例死亡中的112 [76％]; P = .037）和没有受训人员的机构（81例死亡中56 [69％]; P <.001）中，限制决定的频率降低。结论：限制支持的决定很普遍。黑人种族和学员的缺乏与限制决定频率的降低有关。

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