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Med Mal Infect. 2007 Dec;37 Suppl 3:S194-203. doi: 10.1016/j.medmal.2007.09.005.

NO ABSTRACT

PMID:18293503 | PMC:PMC7131670 | DOI:10.1016/j.medmal.2007.09.005

J Med Ethics. 2007 Mar;33(3):128-33. doi: 10.1136/jme.2006.015990.

ABSTRACT

OBJECTIVE: To evaluate feasibility of the guidelines of the Groupe Francophone de Réanimation et Urgence Pédiatriques (French-speaking group of paediatric intensive and emergency care; GFRUP) for limitation of treatments in the paediatric intensive care unit (PICU).

DESIGN: A 2-year prospective survey.

SETTING: A 12-bed PICU at the Hôpital Jeanne de Flandre, Lille, France.

PATIENTS: Were included when limitation of treatments was expected.

RESULTS: Of 967 children admitted, 55 were included with a 2-day median delay. They were younger than others (24 v 60 months), had a higher paediatric risk of mortality (PRISM) score (14 v 4), and a higher paediatric overall performance category (POPC) score at admission (2 v 1); all p<0.002. 34 (50% of total deaths) children died. A limitation decision was made without meeting for 7 children who died: 6 received do-not-resuscitate orders (DNROs) and 1 received withholding decision. Decision-making meetings were organised for 31 children, and the following decisions were made: 12 DNROs (6 deaths and 6 survivals), 4 withholding (1 death and 3 survivals), with 14 withdrawing (14 deaths) and 1 continuing treatment (survival). After limitation, 21 (31% of total deaths) children died and 10 survived (POPC score 4). 13 procedures were interrupted because of death and 11 because of clinical improvement (POPC score 4). Parents' opinions were obtained after 4 family conferences (for a total of 110 min), 3 days after inclusion. The first meeting was planned for 6 days after inclusion and held on the 7th day after inclusion; 80% of parents were immediately informed of the decision, which was implemented after half a day.

CONCLUSIONS: GFRUPs procedure was applicable in most cases. The main difficulties were anticipating the correct date for the meeting and involving nurses in the procedure. Children for whom the procedure was interrupted because of clinical improvement and who survived in poor condition without a formal decision pointed out the need for medical criteria for questioning, which should systematically lead to a formal decision-making process.

PMID:17329379 | PMC:PMC2598266 | DOI:10.1136/jme.2006.015990

Arch Pediatr. 2006 Dec;13(12):1581-8. doi: 10.1016/j.arcped.2006.10.009. Epub 2006 Nov 27.

ABSTRACT

OBJECTIVES: To describe the different pathways of management of intussusception (IS) in infants and children in metropolitan France and to identify paediatric emergency centres that might constitute a surveillance network for IS.

MATERIAL AND METHODS: A questionnaire was sent to 273 paediatric emergency centres distributed across France in 2005. Modalities of diagnosis and treatment of IS had to be precised.

RESULTS: One hundred and sixty-seven centres (61.2%) responded. The response was given by 131 paediatricians (78.4%) and 36 surgeons (21.6%) working in 38 universitary hospitals (22.7%) and 129 general hospitals (77.2%). The mean number of IS treated in each centre in 2004 was 11+/-13.5 (extr. 0 to 70; median 6). Diagnosis of IS required a collaboration between medical and surgical teams in 51.5% of the centres, but in 40.1% the sole medical team was in charge of the diagnosis. Ultrasonography is used for diagnosis by 98.8% of the centres. Reduction with hydrostatic enema and eventually surgery was performed in the same hospital in 44.3%. Other centres systematically or frequently transferred the patients for reduction, mostly towards universitary hospitals (90%).

CONCLUSION: The procedures of IS diagnosis are the same everywhere in France but the pathways of therapeutic management do vary, depending on the availability of surgeons and anaesthetists trained in paediatrics on each site. These disparities will probably change with the implementation of the new plan for sanitary organization in children and adolescents in France. Labellized paediatric emergency centres will gather more surgical patients and could eventually constitute an effective surveillance network for IS.

PMID:17125980 | DOI:10.1016/j.arcped.2006.10.009

Arch Pediatr. 2006 Jun;13(6):623-5. doi: 10.1016/j.arcped.2006.03.038. Epub 2006 May 11.

NO ABSTRACT

PMID:16690264 | DOI:10.1016/j.arcped.2006.03.038

Arch Pediatr. 2005 Oct;12(10):1501-8. doi: 10.1016/j.arcped.2005.04.085. Epub 2005 Jun 2.

ABSTRACT

Several recent French studies have revealed that 40% of death in pediatric intensive care units are associated with withdrawal or limitation of life saving treatments. Because such decisions are common, the Groupe francophone de réanimation et urgences pédiatriques (GFRUP) has decided to publish recommendations in order to help paediatricians dealing with those difficult issues and to improve their decisions. In a first part of the document the ethical principles that imply those guidelines are recalled, followed by definitions of the terms currently employed. The second part contains guidelines regarding decision making process, the way it is applied and organisation of relatives as well as paramedical and medical staff support when the death of a child occurs.

PMID:15935627 | DOI:10.1016/j.arcped.2005.04.085

Ann Fr Anesth Reanim. 2004 Jul;23(7):765-71. doi: 10.1016/j.annfar.2004.03.010.

NO ABSTRACT

PMID:15324974 | DOI:10.1016/j.annfar.2004.03.010