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Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in francophone PICUs

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Abstract

Purpose

Our goal is to assess the prevalence of questioning about the appropriateness of initiating or maintaining life-sustaining treatments (LST) in French-speaking paediatric intensive care units (PICUs) and to evaluate time utilisation related to decision-making processes (DMP).

Methods

18-month, multicentre, prospective, descriptive, observational study in 15 French-speaking PICUs.

Results

Among the 5,602 children admitted, 410 died (7.3%), including 175 after forgoing LST (42.7% of deaths). LST was questioned in 308 children (5.5%) with a prevalence of 13.3 per 100 patient-days. More than 30% of children survived despite the appropriateness of LST being questioned (23% despite a decision to forgo treatment). Median caregiver time spent on making and presenting the decisions was 11 h per child.

Conclusions

In this study, on any given day in each 10-bed PICU, there was more than one child for whom a DMP was underway. Of children, 23% survived despite a decision to forgo LST being made, which underlines the need to elaborate a care plan for these children. Also, DMP represented a large amount of staff time that is undervalued but necessary to ensure optimal palliative practice in PICU.

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Abbreviations

DMP:

Decision-making process

DRNO:

Do-not-resuscitate order

GFRUP:

Groupe Francophone de Réanimation et Urgence Pédiatriques (French-Speaking Group of Paediatric Intensive and Emergency Care)

NPICU:

Neonatal and paediatric intensive care unit

PICU:

Paediatric intensive care unit

PIM2 score:

Paediatric Index of Mortality score

POPC score:

Paediatric Overall Performance Category score

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Acknowledgments

This work was supported by grants from the Réseau Mère-Enfant de la Francophonie and the French Ministry of Health (PHRC AOM08179–NI07014). We thank the investigators for their record keeping and Dr. Susanne Rogers for correcting the manuscript.

Conflict of interest

The authors declare that they have no competing interests.

Author information

Authors and Affiliations

  1. Réanimation Pédiatrique, Hôpital Jeanne de Flandre, CHU de Lille, 59037, Lille Cedex, France

    Robin Cremer & Francis Leclerc

  2. Espace Éthique Hospitalier et Universitaire de Lille, 1 place de Verdun, 59045, Lille Cedex, France

    Robin Cremer

  3. Réanimation Pédiatrique, Hôpital Necker-Enfants Malades, Rue de Sèvres, 75007, Paris, France

    Philippe Hubert

  4. Université Paris V - Descartes, 12 rue de l’école de médecine, 75006, Paris, France

    Philippe Hubert & Grégoire Moutel

  5. Service d’Épidémiologie Régional, Hôpital Calmette, CHU de Lille, 59037, Lille Cedex, France

    Bruno Grandbastien

  6. Université Lille Nord de France, 1 bis rue Georges Lefebvre, 59800, Lille, France

    Bruno Grandbastien

  7. Réseau de Recherche en Éthique de l’INSERM, Laboratoire d’Éthique Médicale, Faculté de Médecine Paris-Descartes, 75270, Paris, France

    Grégoire Moutel

  8. Université Lille Nord de France, UDSL, EA 2694, 1 bis rue Georges Lefebvre, 59800, Lille, France

    Francis Leclerc

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  1. Robin Cremer
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  2. Philippe Hubert
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  3. Bruno Grandbastien
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  4. Grégoire Moutel
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  5. Francis Leclerc
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Consortia

The GFRUP’s study group on forgoing treatments

Corresponding author

Correspondence to Robin Cremer.

Appendix: GFRUP’s study group on forgoing treatments

Appendix: GFRUP’s study group on forgoing treatments

Data were collected in the NPICU/PICUs of the following centres: American Memorial Hospital, CHU de Reims, France; Hôpital Charles Nicolle, CHU de Rouen, France; Hôpital Arnaud de Villeneuve, CHU de Montpellier, France; Hôpital Clocheville, CHU de Tours, France; Hôpital des enfants, CHU de Toulouse, France; Hôpital Hautepierre, CHU de Strasbourg, France; Hôpital Jeanne de Flandre, CHU de Lille, France; Hôpital Femme Mère-enfant, Hospices Civils de Lyon, France, France; Hôpital Morvan, CHU de Brest, France; Hôpital Necker, Assistance Publique-Hôpitaux de Paris, France; Hôpital Nord, CHU de Grenoble, France; Hôpital Reine Fabiola, Bruxelles, Belgium; Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, France; Hôpital Saint Pierre, CHU de Besançon, France; Hôpital Trousseau, Assistance Publique-Hôpitaux de Paris, France.

Investigators were: D. Biarent (Bruxelles, Belgium), T. Blanc (Rouen, France), S. Cantagrel (Tours, France), R. Cremer (Lille, France); S. Dauger (Paris, France), P. Desprez (Strasbourg, France), M. Dobrzynski (Brest, France), G. Emériaud (Grenoble, France), P. Hubert (Paris, France), C. Milesi (Montpellier, France), S. Renolleau (Paris, France), N. Richard (Lyon, France), M. Roque-Gineste (Toulouse, France), O. Noizet-Yverneau (Reims, France), D. Stamm (Lyon, France), I. Wroblewski (Besançon, France).

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Cremer, R., Hubert, P., Grandbastien, B. et al. Prevalence of questioning regarding life-sustaining treatment and time utilisation by forgoing treatment in francophone PICUs. Intensive Care Med 37, 1648–1655 (2011). https://doi.org/10.1007/s00134-011-2320-3

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