Dr. Chris Vadeboncoeur
Feature Article: Wilkinson, D. & J. Weitz. (2016) Dying later, surviving longer. Archives of Disease in Childhood.
I chose this article because over the past several years, this trend has been evident in my institution. The objectives of training in the subspecialty of Pediatric Critical Care Medicine provide the following definition of the subspecialty training program:
“Pediatric Critical Care Medicine is a field of medicine concerned with infants, children and adolescents who have sustained or are at risk of sustaining life threatening, single or multiple organ system failure due to disease or injury. … seeks to provide for the needs of these patients through immediate and continuous observation and intervention so as to restore health and prevent complications. … competent in all aspects of recognizing and managing acutely ill pediatric patients with single or multiple organ system failure requiring ongoing monitoring and support.”
This definition fits well with the critically ill infant or child, whether previously healthy or with a previous history of complex health needs. Many of the former and a few of the latter children who receive this acute care recover quickly and return to their previous baseline or close to that status. Unfortunately, some do not, and a subset of these less fortunate children are the topic of the review discussed in this editorial.
The challenge arises when this latter group of children remains in the intensive care setting for prolonged periods of time. The article and editorial look specifically at the subset that die, but there is perhaps a larger group who survive, with a long intensive care stay, then a long hospital stay before they eventually go home. The moral distress which sometimes arises can affect the care given to the children who die after a prolonged stay, but also the care given to the survivors and their families. The editorial suggests that if the children who will eventually die could be identified, the care provided could be better informed and interventions which will not achieve benefit could possibly be avoided. Whether it could also benefit the moral distress felt by those caring for the children who will survive remains to be seen.