262 Medical and Nurse's Practices Regarding on End of Life, in a Southern Brazilian Pediatric Intensive Care Unit

Abstract

Objective: Evaluate medical and nurse's practices offered in last 24 hours of life of children that died in 2 Brazilian PICU.

Methods: The prospective study was based on: 1) medical chart's analysis of children that died between April- September/2008; 2) Semi- structured interview with the nurses (17). Researchers fielded out 3 protocols looking for data about interventions and care offered in the last 24 hours of life as well as the nurse's participations on EOL decision. According to the treatment offered in the last moments of life, children were classified in 2 groups: ‘full CPR’ and ‘no CPR’. The groups were compared.

Results: 37 deaths were identified in this period (excluded 3 cases-brain death). The CPR was not performed in 50% of children. In 10 of 17 patients not reanimated, the plan for LSL was not recorded in the medical charts. In 80% patients of the ‘no CPR’ group, the vasoactive drugs infusion and ventilator parameters were maintained/increased without differences when compared to “full CPR”(p=1,0 e p=0,6). The nurse's practices evaluated using NAS score in the last 24 hours of life didn't differ even when the patient wasn't reanimated. When nurses were asked about participation on EOL decision, only 30% confirmed it.

Conclusion: Brazilian studies have demonstrated that EOL practice has been a process centralized on the medical perspectives. We observed that nurses and medical attitudes before death didn't change even when the patients were considered terminal illness and the nurses rarely participated on the decision making process.

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