Children continue to die in intensive care

摘要

A study of a UK children's hospital suggests that children with chronic illness continue to die in intensive-care units (ICU; J Med Ethics 2007; 33:255-60). Padmanabhan Ramnarayan and colleagues at Great Ormond Street Hospital, London, UK, analysed demographic and clinical data for 1997-2004, especially hospital location of death (ie, ICU vs non-ICU). 1127 deaths occurred, 966 (86%) in ICU. 140 (12%) children had neoplastic disease-the fourth most common disease in the study. 60 (37%) of the 161 children who died on a ward and 80 (8%) of the 966 children who died in ICU had malignant disease, explains Ramnarayan. "43% of children with cancer who died in hospital died on wards; 57% died in an ICU." 80% of children died in ICU in 1997-98 compared with 91% in 2003-04 (p=0.016). Ramnarayan says: "we have shown...a year-wise increase in this proportion over the past decade". The researchers suggest several reasons for these findings, despite professional ethics guidance, including: unclear prognosis after life-saving treatment; expectations of survival; physician training; and resources.