End-of-life palliative care in the pediatric intensive care unit

Abstract

Introduction: The majority of pediatric deaths occur in pediatric intensive care units (PICUs). The health status of the child in the PICU has a serious impact on his family. End-of-life care (EOLC) can have a lasting impact on bereavement management even after the death of the child.

Purpose: The purpose of the study was to investigate the implementation of Pediatric Palliative Care (PPC) at the end of life in the PICU.
Material – Method: Systematic review performed by searching the international literature in Pubmed and Scopus databases using keywords. The criteria for the inclusion of the articles in the study were: to be written in the English language, to be published in valid scientific journals, be absolutely relevant to the subject of the study, to be published from 2013-2022.

Results: Children with cancer face a high burden of intensive treatments in the PICU. Late PPC onset (>30 days before death) is associated with greater odds of the place of death being the PICU. Parents experienced uncompassionate behavior from staff, poor quality of communication in the PICU, reduced participation in the decision-making process and lack of privacy in their child’s last moments. Children with cancer may have a significant burden of symptoms at the end of life, but positive changes in communication and the way they care and manage death were recorded after PPC implementation. Implementation of PPC was associated with fewer interventions, a higher rate of pain assessment, and better documentation of pain management. Overall there has been an increase in the redirection of care from curative to palliative care, the use of palliative drugs, and a decrease in end-of-life interventions.

Conclusions: A wide range of challenges facing end-of-life children, parents and healthcare professionals is highlighted. Early PPC promotes family-centered care.