The implementation of Polish guidelines regarding ineffective maintenance of organ functions (futile therapy) in pediatric intensive care units: a four-year review

The futile therapy protocol (FTP) is a protocol for the withdrawal or withholding of certain forms of treatment owing to their futility, with the only motivation being the good of the patient, considered individually for each patient (8). Our study aimed to analyze the futile therapy protocols implemented over the past 4 years on the basis of documentation from six major clinical centers. This study included 202 patients, the median age was 24 months, and 42.8% were children up to 1 year of age, including over 70% in the first month of life. As many as 77.7% of patients had incurable diseases from birth, which coincided with the observed impaired functioning in life. Neurological (54.3%) and oncological diseases (16.6%) were the main causes of hospitalization. The median length of survival from preparing the protocol was 6 days (on the basis of available data for 60 patients). As many as 40.6% of patients were discharged to hospice care. Patients who died in intensive care units were statistically younger (p=0.005) and more likely to have chronic diseases (p<0.001) than those discharged to hospice care. The guidelines implemented in the study centers facilitated decision-making regarding the discontinuation of FT. In these centers, FTPs are most frequently applied to children under 1 year of age with underlying chronic illness. Discharging 40% of the analyzed patients from the PICUs was the most beneficial action, minimizing the risk of complications arising from invasive methods involving aggressive treatment. The implementation of FTPs supports the positive role of palliative care.