Dados do Trabalho

Título

COMPARATIVE ANALYSIS OF THE PROFILES OF NEUROLOGICAL AND NON-NEUROLOGICAL PATIENTS ADMITTED TO A PEDIATRIC INTENSIVE CARE UNIT AND FOLLOWED BY THE PEDIATRIC PALLIATIVE CARE TEAM

Introdução

Evaluating the conditions eligible for Pediatric Palliative Care (PPC) and its most prevalent comorbidities managed worldwide, neurological conditions stand out. Although children with neurological disorders make up around 50% of admissions to the Pediatric Intensive Care Unit (PICU), there is limited research on the role of palliative care in neurocritical patients.

Objetivo

To compare the profile of patients with and without neurological conditions admitted to the PICU, aged 0 to 18 years, followed by the PPC team of a quaternary hospital in São Paulo, from March 2023 to June 2024.

Método

Retrospective study with information obtained through review of the medical records of the patients mentioned above. Descriptive epidemiological data were analyzed using absolute and relative frequencies for the evaluated variables, collected through a standardized form by the authors.

Resultados

The PPC Unit followed 96 patients, 60.4% of whom had neurological involvement. Its causes include mostly structural (48.3%) and genetic (25.9%) issues. About reasons for PICU admission, while non-neurological patients (NNP) primarily had infectious complications (31.6%), respiratory ones were most relevant in neurological patients (NP) (29.3%). For PPC interconsultation requests, NNP needed pain management (39.5%), whereas advanced measures limitation discussions were predominant in NP (39.7%). 15.5% of NP had tracheostomy, and 34.5% had gastrostomy, compared to 7.9% of NNP using each device. Analyzing main symptoms, NNP presented pain (87.2%), while NP showed dyspnea (73.7%), pain (71.9%), and dysphagia (63.2%). Polypharmacy was noted in 92.1% of NNP and 84.5% of NP. Regarding the implementation of an Advanced Care Plan (ACP), only 20% of NNP and 22.2% of NP had one elaborated. Finally, only 6.3% of NPs discharged home were referred to home care.

Conclusão

NP stand out as the most prevalent condition in PPC at our PICU, with significant differences in their clinical profiles and care needs, including higher life-support device demands, posing an ethical dilemma about technological dependence and quality of life. Another highlight is the lack of ACPs, despite their importance for individualized care and anticipation of potential events. In this context, healthcare professionals must improve their knowledge of neuropalliative care to offer more compassionate care for these children.

Referências

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Palavras Chave

neuropalliative care; pediatric palliative care; critical care