Timing of Palliative Care Consultation and End-of-Life Care Intensity in Pediatric Patients With Advanced Heart Disease: Single-Center, Retrospective Cohort Study, 2014-2022.

IF 4 2区医学 Q1 CRITICAL CARE MEDICINE Pediatric Critical Care Medicine Pub Date : 2024-11-19 DOI:10.1097/PCC.0000000000003647

Kathryn L Songer, Sarah E Wawrzynski, Lenora M Olson, Mark E Harousseau, Huong D Meeks, Benjamin L Moresco, Claudia Delgado-Corcoran

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Abstract

Objectives: Pediatric patients with advanced heart disease (AHD) often receive high intensity medical care at the end of life (EOL). In this study, we aimed to determine whether receipt and timing of pediatric palliative care (PPC) consultation was associated with EOL care intensity of pediatric patients with AHD.

Design: Retrospective cohort study.

Setting: Single-center, 16-bed cardiac ICU (CICU) in a children's hospital in the Mountain West.

Patients: Pediatric patients (0-21 yr) with AHD treated in the CICU and subsequently died from January 2014 to December 2022.

Interventions: None.

Measurements and main results: We compared demographics, EOL characteristics and care, including medical interventions and mortality characteristics for patients by receipt and timing of PPC (i.e., ≥ 30 d from [early] or < 30 d of death [late]) using chi-square and Wilcoxon rank-sum tests. Of 218 patients, 78 (36%) did not receive PPC, 76 received early PPC (35%), and 64 received late PPC (29%). Compared with patients who did not receive PPC, patients receiving PPC had lower EOL care intensity (77% vs. 96%; p = 0.004) and fewer invasive interventions within 14 days of death (74% vs. 92%; p = 0.004). Receipt of PPC, vs. not, was associated with lower rate of death during cardiopulmonary resuscitation (12% vs. 32%; p = 0.004) and more use of comfort care (23% vs. 3%; p = 0.004). Among patients receiving PPC, early PPC was associated with fewer invasive interventions within 14 days of death (65% vs. 85%; p = 0.033). Care intensity was high for patients with early and late PPC.

Conclusions: Early PPC was associated with fewer invasive interventions within 14 days of death, yet the care intensity at EOL remained high. With early PPC, families likely receive timely psychosocial and advance care planning support without significantly altering goals of care.

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晚期心脏病儿科患者的姑息治疗咨询时间和生命末期护理强度：单中心、回顾性队列研究，2014-2022年。

目的：晚期心脏病（AHD）儿科患者在生命末期（EOL）通常会接受高强度的医疗护理。在这项研究中，我们旨在确定儿科姑息治疗（PPC）咨询的接受情况和时间是否与晚期心脏病儿科患者临终关怀的强度有关：设计：回顾性队列研究：地点：西部山区一家儿童医院的单中心、拥有 16 张病床的心脏重症监护病房（CICU）：2014年1月至2022年12月期间在CICU接受治疗并随后死亡的AHD儿科患者（0-21岁）：无干预措施：我们使用秩方检验和Wilcoxon秩和检验比较了患者的人口统计学特征、临终特征和护理，包括医疗干预和死亡率特征，按接受PPC和PPC时间（即距死亡≥30天[早]或距死亡<30天[晚]）进行比较。在 218 例患者中，78 例（36%）未接受 PPC，76 例接受早期 PPC（35%），64 例接受晚期 PPC（29%）。与未接受临终关怀的患者相比，接受临终关怀的患者的临终关怀强度较低（77% 对 96%；P = 0.004），死亡后 14 天内的侵入性干预较少（74% 对 92%；P = 0.004）。接受心肺复苏术与未接受心肺复苏术的患者相比，心肺复苏术期间的死亡率较低（12% 对 32%；P = 0.004），且更多地使用舒适护理（23% 对 3%；P = 0.004）。在接受 PPC 的患者中，早期 PPC 与死亡后 14 天内较少的侵入性干预有关（65% 对 85%；p = 0.033）。早期和晚期PPC患者的护理强度都很高：结论：早期 PPC 与死亡后 14 天内较少的侵入性干预有关，但死亡后的护理强度仍然很高。通过早期全病程护理，患者家属有可能及时获得社会心理支持和预先护理计划支持，而不会显著改变护理目标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Critical Care Medicine 医学-危重病医学

CiteScore

7.40

自引率

14.60%

发文量

991

审稿时长

3-8 weeks

期刊介绍： Pediatric Critical Care Medicine is written for the entire critical care team: pediatricians, neonatologists, respiratory therapists, nurses, and others who deal with pediatric patients who are critically ill or injured. International in scope, with editorial board members and contributors from around the world, the Journal includes a full range of scientific content, including clinical articles, scientific investigations, solicited reviews, and abstracts from pediatric critical care meetings. Additionally, the Journal includes abstracts of selected articles published in Chinese, French, Italian, Japanese, Portuguese, and Spanish translations - making news of advances in the field available to pediatric and neonatal intensive care practitioners worldwide.