The role of the neuropediatrician in pediatric intensive care unit: Diagnosis, therapeutics and major participation in collaborative multidisciplinary deliberations about life-sustaining treatments' withdrawal

J Toulouse; M Hully; D Brossier; M-L Viallard; L de Saint Blanquat; S Renolleau; M Kossorotoff; I Desguerre

doi:10.1016/j.ejpn.2018.09.002

The role of the neuropediatrician in pediatric intensive care unit: Diagnosis, therapeutics and major participation in collaborative multidisciplinary deliberations about life-sustaining treatments' withdrawal

Eur J Paediatr Neurol. 2019 Jan;23(1):171-180. doi: 10.1016/j.ejpn.2018.09.002. Epub 2018 Sep 14.

Authors

J Toulouse¹, M Hully², D Brossier³, M-L Viallard⁴, L de Saint Blanquat⁵, S Renolleau⁶, M Kossorotoff², I Desguerre⁷

Affiliations

¹ Epileptology, Sleep Disorders and Functional Pediatric Neurology CHU Lyon, 59 Bvd Pinel, 69677, Bron, France. Electronic address: josephtoulouse@gmail.com.
² Paediatric Neurology Department - CHU Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris Cedex 15, France.
³ Paediatric Intensive Care Unit- CHU Caen, Avenue Côte de Nacre, 14033 CAEN Cedex 9, France.
⁴ Paris V Descartes University, France; Pain and Palliative Care Unit- CHU Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris Cedex 15, France.
⁵ Paediatric Intensive Care Unit - CHU Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris Cedex 15, France.
⁶ Paris V Descartes University, France; Paediatric Intensive Care Unit - CHU Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris Cedex 15, France.
⁷ Paediatric Neurology Department - CHU Necker-Enfants-Malades, 149, rue de Sevres, 75743 Paris Cedex 15, France; Paris V Descartes University, France.

PMID: 30262235
DOI: 10.1016/j.ejpn.2018.09.002

Abstract

Background: In Pediatric Intensive Care Unit (PICU) two types of population require the intervention of neuropediatricians (NP): chronic brain diseases' patients who face repetitive and prolonged hospitalizations, and patients with acute brain failure facing the risk of potential neurologic sequelae, and both conditions may result in a limitation of life-sustaining treatments (LLST) decision.

Objective: To assess NP's involvement in LLST decisions within the PICU of a tertiary hospital.

Method: Retrospective study of medical reports of patients hospitalized during 2014 in the Necker-Hospital PICU. Patients were selected using keywords ("cardiorespiratory arrest", "death", "withdrawal of treatment", "palliative care", "acute brain failure", or "chronic neurological disease"), and/or if they were assessed by a NP during the hospitalization. Demographic and medical data were analysed, including the NP's assessment and data about Collaborative Multidisciplinary Deliberation (CMD) to discuss potential LLST.

Results: Among 1160 children, 274 patients were included and 142 (56%) were assessed by a NP during their hospitalization for diagnosis (n = 55) and/or treatment (n = 95) management. NP was required for 59%-100% of patients with neurological acute failure, and for 14-44% of patients with extra neurological failure. A LLST decision was taken after a CMD for 27 (9.8%) of them, and a NP was involved in 19/27 (70%) of these decisions that occurred during the hospitalization (n = 19) or before (n = 8).12 patients died thereafter the LLST decision (40% of the 30 dead patients).

Conclusion: NP are clearly involved in the decision-process of LLST for patients admitted in PICU, claiming for close collaboration to improve current practices and the quality of the care provided to children.

Keywords: Life sutaining treatment; Neuropediatrician; Palliative care; Pediatric intensive care unit; Withdrawal/withholding treatment.

MeSH terms

Adolescent
Child
Child, Preschool
Decision Making
Female
Humans
Infant
Intensive Care Units, Pediatric*
Male
Neurologists*
Palliative Care*
Pediatricians*
Retrospective Studies
Terminal Care
Withholding Treatment*