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Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa?
Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admiss...
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| Format: | Thesis |
| Language: | English |
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Department of Paediatrics and Child Health
2020
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| _version_ | 1867613187785883648 |
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| access_status_str | Open Access |
| author | Wege, Martha Helena |
| author2 | Morrow, Brenda |
| author_browse | Morrow, Brenda Wege, Martha Helena |
| author_facet | Morrow, Brenda Wege, Martha Helena |
| author_sort | Wege, Martha Helena |
| collection | Thesis |
| description | Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/32382 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:09.918Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2020 |
| publishDateRange | 2020 |
| publishDateSort | 2020 |
| publisher | Department of Paediatrics and Child Health |
| publisherStr | Department of Paediatrics and Child Health |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/32382 Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? Wege, Martha Helena Morrow, Brenda Rossouw, Beyra Argent, Andrew Paediatric Critical Care paediatric intensive care unit death end-of-life mortality mode of death Objectives: To describe the characteristics of children who died and their modes of dying in a South African Paediatric Intensive Care Unit (PICU). Design: Retrospective review of data extracted from the Child Healthcare Problem Identification Programme (Child PIP)and the PICU summary system (admission and death records) on children of any age who died in the PICU between 01 January 2013 and 31 December 2017. Setting: Single-centre tertiary institution. Patients: All children who died during PICU admission were included. Measurements and Main Results: Four-hundred and fifty-one (54% male; median (IQR) age 7 (1-30) months) patients died in PICU on median (IQR) 3 (1-7) days after PICU admission; 103 (22.8%) had a cardiac arrest prior to PICU admission. Mode of death in 23.7% (n=107) was withdrawal of life sustaining therapies; 36.1% (n=163) died after limitation of life sustaining therapies; 22.0% (n=99) died after failed resuscitation and 17.3% (n=78) were diagnosed brain dead. Ultimately, 270 (60%) children died after the decision to limit or withdraw life sustaining therapies. There was no difference in the number of deaths during office and after-hours periods (45.5% vs. 54%; p = 0.07). Severe sepsis (21.9%) was the most common condition associated with death, followed by cardiac disease (18.6%).Ninety-four (20.8%) patients were readmitted to the PICU within the same year; 278 (61.6%) had complex chronic disorders. During the last phase of life, 75.0% (n=342) were on inotropes, 95.9% (n=428) were ventilated, 12.0% (n=45) received inhaled nitric oxide and 10.8% (n=46) renal replacement therapy. Only 1.5% (n=7) of children became organ donors and postmortems were done in 47.2% (n=213) of the patients. Conclusions: Most PICU deaths occurred after a decision to limit or withdraw life-sustaining therapy. Severe sepsis was the most common condition associated with death. Referral for organ donation was extremely rare. 2020-11-11T11:45:49Z 2020-11-11T11:45:49Z 2020 2020-11-10T09:49:44Z Master Thesis Masters MPhil http://hdl.handle.net/11427/32382 eng application/pdf Department of Paediatrics and Child Health Faculty of Health Sciences |
| spellingShingle | Paediatric Critical Care paediatric intensive care unit death end-of-life mortality mode of death Wege, Martha Helena Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? |
| thesis_degree_str | Master's |
| title | Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? |
| title_full | Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? |
| title_fullStr | Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? |
| title_full_unstemmed | Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? |
| title_short | Why, how and when do children die in a Paediatric Intensive Care Unit (PICU) in South Africa? |
| title_sort | why how and when do children die in a paediatric intensive care unit picu in south africa |
| topic | Paediatric Critical Care paediatric intensive care unit death end-of-life mortality mode of death |
| url | http://hdl.handle.net/11427/32382 |
| work_keys_str_mv | AT wegemarthahelena whyhowandwhendochildrendieinapaediatricintensivecareunitpicuinsouthafrica |