Comfort care practice in pediatric intensive care units; practitioner-oriented survey from Saudi Arabia

Staff in the Pediatric intensive care unit (PICU) often need to make difficult decisions regarding critically-ill patients with poor outcomes and extremely poor prognosis.. The study aimed to explore the medical and ethical practice related to palliative care among pediatric intensivists in Saudi Arabia. The study was designed as a cross-sectional, web-based survey targeting all clinicians working in any PICU in Saudi Arabia. Only 30% of pediatric intensive care physicians have a well-established program for discharging chronic patients home. Although 70% of the participants have an ethical committee in their hospital, 20% think that it is not adding much to their practice or supporting their medical decisions. Notably,decision of comfort care or Do Not Resuscitate (DNR) was intiated by consultants in 76.4% of cases and 23.6% by other pediatric specialists. Furthermore, 60% of the pediatricians signed the comfort care or DNR form first and then later informed the family about such a decision. No significant difference was found when comparing the responses to different clinical comfort care scenarios between participants with < 5 year-experience and those with > 5 year-experience in the PICU. ( P > 0.05 across all scenarios using Chi 2 test). More guidelines and policies about palliative care practice in PICU are needed. Given that palliative care practice is a new clinical practice area, these guidelines and policies should also be combined with the training for all staff, with special attention to family/patient communication and consultation.