Abstract
In the critical care environment, what begins as cure-oriented and life-extending treatment may become unsuccessful in overcoming the patient's increasingly complex pathophysiology. A case from the neonatal intensive care unit is presented and used to elaborate upon care transitions toward palliative and supportive care that can be rendered in the hospital, at home or in a hospice facility. Successful transitions may rest upon anticipatory guidance by the primary physician and team, or a consultant, to facilitate and enable parents and team members alike in addressing the hard realities that cure, or even successful ICU discharge, is unlikely. A simple mechanism of addressing and accommodating a family's wishes is provided.
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Abbreviations
- NICU:
-
neonatal intensive care unit
- VSD:
-
ventricular septal defect
References
Biard JM, Wilson RD, Johnson MP, Hedrick HL, Schwarz U, Flake AW et al. Prenatally diagnosed giant omphaloceles: short- and long-term outcomes. Prenat Diagn 2004; 24: 434–439.
Now I Lay Me Down To Sleep. Accessed on-line 12 October 2010 at URL http://www.nowilaymedowntosleep.org/.
Meert KL, Eggly S, Pollack M, Anand KJ, Zimmerman J, Carcillo J et al. Parents' perspectives on physician-parent communication near the time of a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2008; 9: 2–7.
Meert KL, Briller SH, Schim SM, Thurston CS . Exploring parents' environmental needs at the time of a child's death in the pediatric intensive care unit. Pediatr Crit Care Med 2008; 9: 623–628.
Meert KL, Briller SH, Schim SM, Thurston C, Kabel A . Examining the needs of bereaved parents in the pediatric intensive care unit: a qualitative study. Death Studies 2009; 33: 712–740.
Miceli P, Clark P . Your patient—my child. Seven priorities for improving pediatric care from the parent's perspective. J Nurs Quality 2005; 20: 43–53.
Meyer EC, Burns JB, Griffith JL, Truog RD . Parental perspectives on end-of-life care in the pediatric intensive care unit. Crit Care Med 2002; 30: 226–231.
Meyer EC, Ritholz MD, Burns JB, Truog RD . Improving the quality of end-of-life care in the pediatric intensive care unit: priorities and recommendations. Pediatrics 2006; 117: 649–657.
Truog RD, Meyer EC, Burns JD . Toward interventions to improve end-of-life care in the pediatric intensive care unit. Crit Care Med 2006; 34: S373–S379.
Yee W, Ross S . Communicating with parents of high risk infants in neonatal intensive care. Pediatr Child Health 2006; 11: 291–294.
Fox S, Platt FW, White MK, Hulac P . Talking about the unthinkable: perinatal/neonatal communication issues and procedures. Clin Perinatol 2005; 32: 157–170.
Rao JK, Anderson LA, Inui TS, Frankel RM . Communication interventions make a difference in conversations between physicians and patients. Med Care 2007; 45: 340–349.
Meyer EC, Tunick RA . Family adjustment and support. In: Walsh D (ed.) Palliative Medicine. Saunders Elsevier: Philadelphia, PA, 2008 pp 1093–1097.
Gillis J, Rennick J . Affirming love in the pediatric intensive care unit. Pediatr Crit Care Med 2006; 7 (2): 165–168.
Browning DM, Meyer EC, Truog RD, Solomon MZ . Difficult conversations in health care: cultivating relational learning to address the hidden curriculum. Acad Med 2007; 82: 905–913.
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Carter, B., Brown, J., Brown, S. et al. Four wishes for Aubrey. J Perinatol 32, 10–14 (2012). https://doi.org/10.1038/jp.2011.171
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DOI: https://doi.org/10.1038/jp.2011.171
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