@article{ref1,
title="Modes of death in the pediatric intensive care unit: withdrawal and limitation of supportive care",
journal="Critical care medicine",
year="1993",
author="Vernon, D. D. and Dean, J. M. and Timmons, O. D. and Banner, W. and Allen-Webb, E. M.",
volume="21",
number="11",
pages="1798-1802",
abstract="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 children's 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 categories: brain 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.<p /><p>Language: en</p>",
language="en",
issn="0090-3493",
doi="",
url="http://dx.doi.org/"
}