EN-TING WUCHING-CHIA WANGSHU-CHIEN HUANGChen, Chieh-HoChieh-HoChenSHIANN-TANG JOUChen, Yih-CharngYih-CharngChenMEI-HWAN WUFRANK LEIGH LU2021-10-042021-10-0420211529-7535https://www.scopus.com/inward/record.uri?eid=2-s2.0-85112306752&doi=10.1097%2fPCC.0000000000002715&partnerID=40&md5=6cf00385153f618d91101f84cff0e852https://scholars.lib.ntu.edu.tw/handle/123456789/583924Objectives: Medical advances and the National Health Insurance coverage in Taiwan mean that mortality in the PICU is low. This study describes change in modes of death and end-of-life care in a single center, 2011-2017. Setting: Multidisciplinary PICU in a tertiary referral Children's Hospital in Taiwan. Patients: There were 316 deaths in PICU patients. Interventions: Palliative care consultation in the PICU service occurred after the 2013 "Hospice Palliative Care Act" revision. Measurements and main results: In the whole cohort, 22 of 316 patients (7%) were determined as "death by neurologic criteria". There were 94 of 316 patients (30%) who had an event needing cardiopulmonary resuscitation within 24 hours of death: 17 of these patients (17/94; 18%) died after failed cardiopulmonary resuscitation without a do-not-resuscitate order, and the other 77 of 94 patients (82%) had a do-not-resuscitate order after cardiopulmonary resuscitation. Overall, there were 200 of 316 patients (63%) who had a do-not-resuscitate order and were entered into the palliative program: 169 of 200 (85%) died after life-sustaining treatment was limited, and the other 31 of 200 (15%) died after life-sustaining treatment was withdrawn. From 2011 to 2017, the time-trend in end-of-life care showed the following associations: 1) a decrease in PICU mortality utilization rate, from 22% to 7% (p < 0.001); 2) a decrease in use of catecholamine infusions after do-not-resuscitate consent, from 87% to 47% (p = 0.001), in patients having limitation in life-sustaining treatment; and 3) an increase in withdrawal of life-sustaining treatment, from 4% to 31% (p < 0.001). Conclusions: In our practice in a single PICU-center in Taiwan, we have seen that the integration of a palliative care consultation service, developed after the revision of a national "Palliative Care Act," was associated with increased willingness to accept withdrawal of life-sustaining treatment and a lowered PICU care intensity at the end-of-life.endo-not-resuscitateend-of-life carepalliative carepediatric intensive care unitwithdraw life-sustaining therapiesjournal article10.1097/PCC.0000000000002715337670732-s2.0-85112306752