• D D Vernon, J M Dean, O D Timmons, W Banner, and E M Allen-Webb.
• Department of Pediatrics, University of Utah, Salt Lake City.
• Crit. Care Med. 1993 Nov 1;21(11):1798-802.

ObjectiveTo determine the frequency of withdrawal or limitation of supportive care for children dying in a pediatric intensive care unit (ICU).DesignRetrospective review of medical records.SettingPediatric ICU in a tertiary care children's hospital.PatientsAll children dying in the pediatric ICU over a 54-month period (n = 300).InterventionsMedical record review.Measurements And Main ResultsData 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%).ConclusionsIn 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.

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