Futile therapy protocols: A 3-year review of the implementation of Polish guidelines on ineffective organ function maintenance in pediatric intensive care unit—A pilot study

Abstract

Background and objectives: This study aimed to evaluate the implementation and impact of futile therapy (FT) protocols in pediatric intensive care units (PICUs) in Poland. Methods: A retrospective analysis 48 futile therapy protocols signed at three academic pediatric intensive care units (PICUs) in southern Poland. A designated individual at each of the hospitals gathered detailed data from the protocols. Results: The children’s ages ranged from 1 month to 18 years, the primary diagnoses were neurological conditions (n = 22, 45.83%), oncological conditions (n = 11, 22.92%), and prematurity (n = 9, 19.75%). The most common concomitant complications included severe birth asphyxia (n = 21, 43.75%), chronic respiratory failure (n = 18, 37.50%), circulatory failure (n = 10, 20.85%), and acute respiratory failure (n = 10, 20.85%). More than one-third of the patients were discharged (n = 17, 35.42%), while the remaining patients continued treatment in their primary wards (n = 31, 64.58%). Information on the 37 patients treated at these two centers shows that most (n = 25, 67.57%) died in the ward where they were hospitalized. The survival time after the protocol was signed ranged from 2 to 705 days, with a median of 42 days. Conclusions: The guidelines implemented in the study centers facilitated decision-making regarding the discontinuation of FT. The protocol was most frequently applied to newborns and children under 1 year of age. A median of survival time after implement FTP affirming the positive role of palliative care.