The purpose of this paper is to describe how end-of-life care is managed when life-support limitation is decided in a Pediatric Intensive Care Unit and to analyze the influence of the further development of the Palliative Care Unit. A 15-year retrospective study of children who died after life-support limitation was initiated in a pediatric intensive care unit. Patients were divided into two groups, pre- and post-palliative care unit development. Epidemiological and clinical data, the decision-making process, and the approach were analyzed. Data was obtained from patient medical records. One hundred seventy-five patients were included. The main reason for admission was respiratory failure (86/175). A previous pathology was present in 152 patients (61/152 were neurological issues). The medical team and family participated together in the decision-making in 145 cases (82.8%). The family made the request in 10 cases (9 vs. 1, p = 0.019). Withdrawal was the main life-support limitation (113/175), followed by withholding life-sustaining treatments (37/175). Withdrawal was more frequent in the post-palliative group (57.4% vs. 74.3%, p = 0.031). In absolute numbers, respiratory support was the main type of support withdrawn. The main cause of life-support limitation was the unfavourable evolution of the underlying pathology. Families were involved in the decision-making process in a high percentage of the cases. The development of the Palliative Care Unit changed life-support limitation in our unit, with differences detected in the type of patient and in the strategy used. Increased confidence among intensivists when providing end-of-life care, and the availability of a Palliative Care Unit may contribute to improvements in the quality of end-of-life care.

中文翻译：

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儿科重症监护病房的临终关怀：姑息治疗病房发展的影响。

本文的目的是描述当儿科重症监护病房决定生命支持限制时如何管理临终关怀，并分析姑息治疗病房进一步发展的影响。一项针对因生命支持限制而死亡的儿童的 15 年回顾性研究在儿科重症监护病房启动。患者被分为两组，即姑息治疗前和姑息治疗后。分析了流行病学和临床数据、决策过程和方法。数据是从患者的医疗记录中获得的。其中包括一百七十五名患者。入院的主要原因是呼吸衰竭（86/175）。152 名患者先前存在病理状况（61/152 为神经系统问题）。医疗团队和家属共同参与决策的有145例（82.8%）。家庭在 10 例中提出了请求（9 比 1，p = 0.019）。戒断是主要的生命支持限制 (113/175)，其次是停止生命维持治疗 (37/175)。姑息治疗后组的戒断更为频繁（57.4% vs. 74.3%，p = 0.031）。从绝对数量来看，呼吸支持是撤回的主要支持类型。生命支持受限的主要原因是潜在病理学的不利演变。在大部分案件中，家庭参与决策过程。姑息治疗病房的发展改变了我们病房的生命支持限制，在患者类型和所使用的策略方面发现了差异。重症医生在提供临终关怀时的信心增强，以及姑息治疗病房的可用性可能有助于提高临终关怀的质量。