Deaths in a paediatric intensive care unit: A review over three years

Background: Deaths in paediatric intensive care units (PICUs) are sometimes unavoidable. The decision to withdraw or withhold treatment is important especially in places where there are limited resources.

Objective: To evaluate the modes of death and underlying diseases of patients’ deaths in a PICU.

Method: We retrospectively reviewed the clinical features and management of consecutive non-survivors in the PICU at a tertiary care University Hospital in a developing country over a three-year period.

Results: Of 1,389 admissions, 110 (8%) patients died. The median age of the deaths was 4.1 years. Most (86%) patients had underlying diseases including congenital heart diseases (27%) and malignancies (23%). Forty-seven patients died with active treatment (AT), 60 died with life support limitation (LSL), and 3 had brain death (BD). The median length of stay (LOS) in AT group was 3 days and this was not significantly different (p=0.056) from the median LOS in LSL group which was 5 days. LOS less than 3 days, postoperative cases and underlying diseases of the cardiovascular system were factors associated with the AT group. The three common complications leading to death were multi-organ failure, septicaemia with septic shock and respiratory failure.

Conclusions: Congenital heart diseases and malignancies were the two common underlying diseases found in non-survivors. LSL was the common mode of death in PICU.

(Key words: paediatric intensive care unit; mode of death; life support limitation; active treatment; brain death)

DOI: http://dx.doi.org/10.4038/sljch.v41i4.4977