| Fin de la vida en la unidad de cuidados intensivos neonatales |
End of life in the neonatal intensive care unit. Moura H, Costa V, Rodrigues M, Almeida F, Maia T, Guimarães H. Serviço de Neonatologia do Centro Hospitalar Porto, Portugal. Clinics (Sao Paulo). 2011;66(9):1569-72.Abstract PURPOSE: Death at the beginning of life is tragic but not uncommon in neonatal intensive care units. In Portugal, few studies have examined the circumstances surrounding the final moments of neonates. We evaluated the care given to neonates and their families in terminal situations and the changes that had occurred one decade later. DESIGN AND METHODS: We analyzed 256 charts in a retrospective chart review of neonatal deaths between two periods (1992-1995 and 2002-2005) in a level III neonatal intensive care unit. RESULTS: Our results show differences in the care of dying infants between the two periods. The analysis of the 2002-2005 cohort four years revealed more withholding and withdrawing of therapeutic activities and more effective pain and distress relief; however, on the final day of life, 95.7% of the infants received invasive ventilatory support, 76.3% received antibiotics, 58.1% received inotropics, and 25.8% received no opioid or sedative administration. The 2002-2005 cohort had more spiritual advisor solicitation, a higher number of relatives with permission to freely visit and more clinical meetings with neonatologists. Interventions by parents, healthcare providers and ethics committees during decision-making were not documented in any of the charts. Only eight written orders regarding therapeutic limitations and the adoption of palliative care were documented; seven (87.5%) were from the 2002-2005 cohort. Parental presence during death was more frequent in the latter four years (2002-2005 cohort), but only 21.5% of the parents wanted to be present at that moment. CONCLUSION: Despite an increase in the withholding and withdrawing of therapeutic activities and improvements in pain management and family support, many neonates still receive curative and aggressive practices at the end of life. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3164406/pdf/cln-66-09-1569.pdf |
| Decisiones al final de la vida en terapia intensiva neonatal en Holanda |
End-of-life decisions in Dutch neonatal intensive care units. Verhagen AA, Dorscheidt JH, Engels B, Hubben JH, Sauer PJ. Department of Pediatrics, University Medical Centre, 9700 RB Groningen, the Netherlands. e.verhagen@bkk.umcg.nlArch Pediatr Adolesc Med. 2009 Oct;163(10):895-901.Abstract OBJECTIVE: To clarify the practice of end-of-life decision making in severely ill newborns. DESIGN: Retrospective descriptive study with face-to-face interviews.SETTING: The 10 neonatal intensive care units in the Netherlands from October 2005 to September 2006. PATIENTS: All 367 newborn infants who died in the first 2 months of life in Dutch neonatal intensive care units. Adequate documentation was available in 359 deaths. OUTCOME MEASURES: Presence of end-of-life decisions, classification of deaths in 3 groups, and physicians' considerations leading to end-of-life decisions. RESULTS: An end-of-life decision preceded death in 95% of cases, and in 5% treatment was continued until death. Of all of the deaths, 58% were classified as having no chance of survival and 42% were stabilized newborns with poor prognoses. Withdrawal of life-sustaining therapy was the main mode of death in both groups. One case of deliberate ending of life was found. In 92% of newborns with poor prognoses, end-of-life decisions were based on patients' future quality of life and mainly concerned future suffering. Considerations regarding the infant's present state were made in 44% of infants. CONCLUSIONS: Virtually all deaths in Dutch neonatal intensive care units are preceded by the decision to withdraw life-sustaining treatment and many decisions are based on future quality of life. The decision to deliberately end the life of a newborn may occur less frequently than was previously assumed. http://archpedi.ama-assn.org/cgi/reprint/163/10/895 |
| Vivir con una decisión crucial: un estudio cualitativo de las narrativas de los padres tres años después de la pérdida de su recién nacido en la UCIN |
Living with a crucial decision: a qualitative study of parental narratives three years after the loss of their newborn in the NICU. Caeymaex L, Speranza M, Vasilescu C, Danan C, Bourrat MM, Garel M, Jousselme C. Centre Hospitalier Intercommunal de Creteil, Newborn Intensive Care Unit, Department of Research in Ethics EA 1610 Studies on Science and Techniques, Paris-South University, Creteil, France. laurencecmx@yahoo.frPLoS One. 2011;6(12):e28633. Epub 2011 Dec 14. Abstract BACKGROUND: The importance of involving parents in the end-of-life decision-making-process (EOL DMP) for their child in the neonatal intensive care unit (NICU) is recognised by ethical guidelines in numerous countries. However, studies exploring parents' opinions on the type of involvement report conflicting results. This study sought to explore parents' experience of the EOL DMP for their child in the NICU. METHODS: The study used a retrospective longitudinal design with a qualitative analysis of parental experience 3 years after the death of their child in four NICUs in France. 53 face-to-face interviews and 80 telephone interviews were conducted with 164 individuals. Semi-structured interviews were conducted to explore how parents perceived their role in the decision process, what they valued about physicians' attitudes in this situation and whether their long-term emotional well being varied according to their perceived role in the EOL DMP. FINDINGS: Qualitative analysis identified four types of perceived role in the DMP: shared, medical, informed parental decision, and no decision. Shared DM was the most appreciated by parents. Medical DM was experienced as positive only when it was associated with communication. Informed parental DM was associated with feelings of anxiousness and abandonment. The physicians' attitudes that were perceived as helpful in the long term were explicit sharing of responsibility, clear expression of staff preferences, and respectful care and language toward the child. INTERPRETATION: Parents find it valuable to express their opinion in the EOL DMP of their child. Nonetheless, they do need continuous emotional support and an explicit share of the responsibility for the decision. As involvement preferences and associated feelings can vary, parents should be able to decide what role they want to play. However, our study suggests that fully autonomous decisions should be misadvised in these types of tragic choices. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3237456/pdf/pone.0028633.pdf |
|
No hay comentarios:
Publicar un comentario