• Carme Agra-Tuñas, Emilio Rodriguez-Ruiz, Elva Rodríguez Merino, and MOdos de Morir en UCI Pediátrica-2 (MOMUCIP-2) study group of the Spanish Society of Paediatric Intensive Care (SECIP).
• Paediatric Critical, Intermediate and Palliative Care Division, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain.
• Pediatr Crit Care Me. 2020 Sep 1; 21 (9): e610-e616.

ObjectivesTo describe how children currently die in Spanish PICUs, their epidemiologic characteristics and clinical diagnoses.DesignProspective multicenter observational study.SettingEighteen PICUs participating in the MOdos de Morir en UCI Pediátrica-2 (MOMUCI-2) study in Spain.PatientsChildren 1 to 16 years old who died in PICU during 2017 and 2018.InterventionsNone.Measurements And Main ResultsDuring the 2-year study period, 250 deaths were recorded. Seventy-three children (29.3%) were younger than 1 year, 131 (52.6%) were between 1 and 12 years old, and 45 (18.1%) were older than 12. One-hundred eighty patients (72%) suffered from an underlying chronic disease, 54 (21.6%) had been admitted to PICU in the past 6 months, and 71 (28.4%) were severely disabled upon admission. Deaths occurred more frequently on the afternoon-night shift (62%) after a median PICU length of stay of 3 days (1-12 d). Nearly half of the patients died (48.8%) after life-sustaining treatment limitation, 71 died (28.4%) despite receiving life-sustaining therapies and cardiopulmonary resuscitation, and 57 (22.8%) were declared brain dead. The most frequent type of life-sustaining treatment limitation was the withdrawal of mechanical ventilation (20.8%), followed by noninitiation of cardiopulmonary resuscitation (18%) and withdrawal of vasoactive drugs (13.7%). Life-sustaining treatment limitation was significantly more frequent in patients with an underlying neurologic-neuromuscular disease, respiratory disease as the cause of admission, a previous admission to PICU in the past 6 months, and severe disability. Multivariate analyses indicated that life-sustaining treatment limitation, chronicity, and poor Pediatric Cerebral Performance Category score were closely related.ConclusionsCurrently, nearly half of the deaths in Spanish PICUs occur after the withdrawal of life-sustaining treatments. These children are more likely to have had previous admissions to the PICU, be severely disabled or to suffer from chronic diseases. Healthcare professionals who treat critically ill children ought to be aware of this situation and should therefore be prepared and trained to provide the best end-of-life care possible.

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