• Karen Dryden-Palmer, Cathy Haut, Samantha Murphy, and Patricia Moloney-Harmon.
• Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, ON, Canada.
• Pediatr Crit Care Me. 2018 Aug 1; 19 (8S Suppl 2): S19-S25.

ObjectivesTo describe practical considerations and approaches to best practices for end-of-life care for critically ill children and families in the PICU.Data SourcesLiterature review, personal experience, and expert opinion.Study SelectionA sampling of the foundational and current evidence related to the withdrawal of life-sustaining therapies in the context of childhood critical illness and injury was accessed.Data ExtractionModerated by the authors and supported by lived experience.Data SynthesisNarrative review and experiential reflection.ConclusionsConsequences of childhood death in the PICU extend beyond the events of dying and death. In the context of withdrawal of life-sustaining therapies, achieving a quality death is impactful both in the immediate and in the longer term for family and for the team. An individualized approach to withdrawal of life-sustaining therapies that is informed by empiric and practical knowledge will ensure best care of the child and support the emotional well-being of child, family, and the team. Adherence to the principles of holistic and compassionate end-of-life care and an ongoing commitment to provide the best possible experience for withdrawal of life-sustaining therapies can achieve optimal end-of-life care in the most challenging of circumstances.

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