J Pediatr Intensive Care 2017; 06(02): 077-082
DOI: 10.1055/s-0036-1584680
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Considerations in Caring for Adult Patients in the Pediatric Intensive Care Unit

Jennifer Susan Needle
1   Division of Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, United States
,
Ashley Bjorklund
1   Division of Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, United States
,
Sameer Gupta
1   Division of Critical Care, Department of Pediatrics, University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota, United States
› Author Affiliations
Further Information

Publication History

03 September 2015

11 December 2015

Publication Date:
24 June 2016 (online)

Abstract

Pediatric providers are caring for a growing number of adults in pediatric in-patient settings due to the increasing survival of patients with historically pediatric disease. Beyond understanding the unique medical management of these patients, adult-specific ethical and legal issues must be considered. The aim of this article is to discuss four major issues unique to caring for adult patients: advance directives, confidentiality, decision-making capacity, and palliative care. To our knowledge, no literature exists focusing on the consideration of these specific concepts for the pediatric provider. An understanding of these issues in caring for adult patients in pediatric settings will enable pediatric practitioners to better consider patient autonomy, protect patient privacy, and ensure appropriate decision-making in critically ill patients.

Note

There is no source of funding or support for the submitted work. The submitted work has not been presented previously.


 
  • References

  • 1 Goodman DM, Hall M, Levin A , et al. Adults with chronic health conditions originating in childhood: inpatient experience in children's hospitals. Pediatrics 2011; 128 (1) 5-13
  • 2 Edwards JD, Houtrow AJ, Vasilevskis EE, Dudley RA, Okumura MJ. Multi-institutional profile of adults admitted to pediatric intensive care units. JAMA Pediatr 2013; 167 (5) 436-443
  • 3 Hartog CS, Peschel I, Schwarzkopf D , et al. Are written advance directives helpful to guide end-of-life therapy in the intensive care unit? A retrospective matched-cohort study. J Crit Care 2014; 29 (1) 128-133
  • 4 Rao JK, Anderson LA, Lin FC, Laux JP. Completion of advance directives among U.S. consumers. Am J Prev Med 2014; 46 (1) 65-70
  • 5 Liberman DB, Pham PK, Nager AL. Pediatric advance directives: parents' knowledge, experience, and preferences. Pediatrics 2014; 134 (2) e436-e443
  • 6 Durall A, Zurakowski D, Wolfe J. Barriers to conducting advance care discussions for children with life-threatening conditions. Pediatrics 2012; 129 (4) e975-e982
  • 7 Houben CH, Spruit MA, Groenen MT, Wouters EF, Janssen DJ. Efficacy of advance care planning: a systematic review and meta-analysis. J Am Med Dir Assoc 2014; 15 (7) 477-489
  • 8 National Consensus Project . Available online at: www.nationalconsensusproject.org . Accessed December 26, 2014
  • 9 Nelson JE, Curtis JR, Mulkerin C , et al; Improving Palliative Care in the ICU (IPAL-ICU) Project Advisory Board. Choosing and using screening criteria for palliative care consultation in the ICU: a report from the Improving Palliative Care in the ICU (IPAL-ICU) Advisory Board. Crit Care Med 2013; 41 (10) 2318-2327
  • 10 Weissman DE, Meier DE. Identifying patients in need of a palliative care assessment in the hospital setting: a consensus report from the Center to Advance Palliative Care. J Palliat Med 2011; 14 (1) 17-23
  • 11 Friebert S, Osenga K. Pediatric palliative care referral criteria. Center to Advance Palliative Care;2009. Available at http://www.capc.org/old-tools-for-palliative-care-programs/clinical-tools/consult-triggers/pediatric-palliative-care-referral-criteria.pdf . Accessed June 13, 2016
  • 12 Norton SA, Hogan LA, Holloway RG, Temkin-Greener H, Buckley MJ, Quill TE. Proactive palliative care in the medical intensive care unit: effects on length of stay for selected high-risk patients. Crit Care Med 2007; 35 (6) 1530-1535
  • 13 Morrison RS, Penrod JD, Cassel JB , et al; Palliative Care Leadership Centers' Outcomes Group. Cost savings associated with US hospital palliative care consultation programs. Arch Intern Med 2008; 168 (16) 1783-1790
  • 14 Smith TJ, Coyne P, Cassel B, Penberthy L, Hopson A, Hager MA. A high-volume specialist palliative care unit and team may reduce in-hospital end-of-life care costs. J Palliat Med 2003; 6 (5) 699-705
  • 15 Berlinger N, Jennings B, Wolf SM. The Hastings Center Guidelines for Decisions on Life-Sustaining Treatment and Care Near the End of Life. 2nd ed. New York, NY: Oxford University Press; 2013
  • 16 Informed consent, parental permission, and assent in pediatric practice. Committee on Bioethics, American Academy of Pediatrics. Pediatrics 1995; 95 (2) 314-317
  • 17 Appelbaum PS. Clinical practice. Assessment of patients' competence to consent to treatment. N Engl J Med 2007; 357 (18) 1834-1840
  • 18 Sessums LL, Zembrzuska H, Jackson JL. Does this patient have medical decision-making capacity?. JAMA 2011; 306 (4) 420-427
  • 19 Wendler D, Rid A. Systematic review: the effect on surrogates of making treatment decisions for others. Ann Intern Med 2011; 154 (5) 336-346
  • 20 Raymont V, Bingley W, Buchanan A , et al. Prevalence of mental incapacity in medical inpatients and associated risk factors: cross-sectional study. Lancet 2004; 364 (9443): 1421-1427
  • 21 Marson DC, McInturff B, Hawkins L, Bartolucci A, Harrell LE. Consistency of physician judgments of capacity to consent in mild Alzheimer's disease. J Am Geriatr Soc 1997; 45 (4) 453-457
  • 22 The Aid to Capacity Evaluation (ACE) . Available online at: http://www.jcb.utoronto.ca/tools/ace.shtml . Accessed December 26, 2014