Pediatric Critical Care Medicine | 2021
There’s No Place Like Home*
Abstract
Choice in the place of death is one of the essential standards in children’s endof-life and palliative care (1). Although pediatric intensive care (PIC) mortality has been falling globally for some time, the population we admit has become more complex. An increasing number of children live throughout childhood with life-limiting conditions, which lead to multiple critical care admissions, whether for postoperative organ support, during intercurrent infections, or for exacerbations of their underlying condition. For some children, continuing life-sustaining therapy in PIC may no longer be in their best interests; this includes those with chronic illness and those who have sadly sustained a sudden catastrophic problem. As withdrawal/withholding life-sustaining therapy (WWLST) precedes up to 70% of deaths in PIC (2), offering this choice to the families of a suitable dying child within the critical care environment should be routine. However, there are very limited international data to understand how widespread compassion at extubation at home (CEAH), or elsewhere, actually is. Initial CEAH occurred late last century, although few cases were reported (3). As the process became standardized in some settings, case series emerged (4), and local policies and pathways were published (5, 6). The article by Woodruff et al (7) published in this issue of Pediatric Critical Care Medicine helpfully adds to this in bringing together essential principles for all PIC teams to consider in offering CEAH to families facing their child’s end-of-life in PIC.