In PICU treatment is often invasive and aggressive to combat severe infections and diseases with the goal of survival of all children admitted for intensive care. However in a small cohort of patients re-orientation of care becomes most appropriate. The PICU palliative care team works (as encouraged by the Royal College of Paediatrics and Child Health-RCPCH) to promote in these cases “palliative care and ensure that the child’s needs continue to be assessed and met as a re-direction of management from life-sustaining treatment to palliation represents a change in beneficial aims and objectives and does not constitute a withdrawal of care.”
Decisions regarding re-orientation of care are complex and involve a multi-disciplinary team with the family closely involved in the process of shared decision making. There is a guideline in place that details the process involved in reorientation of care with options given to the family, where appropriate, of extubation outside the PICU at home or hospice if the family so wishes.