Physicians’ attitudes when faced with life-threatening events in children with severe neurological disabilities

<b>Purpose:</b> Children with severe neurological disabilities are at an increased risk of acute, life-threatening events. We assessed physicians’ attitudes when making decisions in these situations. <b>Methods:</b> We surveyed physicians in pediatric intensive care, neurology, and rehabilitation units in Swiss hospitals. The questionnaire explored participants’ attitudes toward life-threatening situations in two scenarios: a child with profound intellectual and multiple disabilities (PIMD) and an infant with spinal muscular atrophy (SMA) type I. <b>Results:</b> The participation rate was 55% (52/95). There was a consensus favoring non-invasive ventilation and comfort care as well as avoiding tracheostomy and invasive ventilation. For the child with PIMD, 61% of participants opposed cardiopulmonary resuscitation (CPR), 51% for the child with SMA. Physicians with over 20 years of experience were significantly more opposed to providing CPR than less experienced colleagues. <b>Conclusions:</b> Physicians held different views, influenced by personal factors. This highlights the importance of standardizing multidisciplinary processes toward approaching these complex situations.

目的：重症神经系统残疾儿童发生急性危及生命事件的风险显著升高。本研究旨在评估医师在此类临床情境下进行决策时的态度。方法：我们对瑞士医院儿科重症监护科、神经内科及康复科的医师开展了问卷调查。问卷围绕两种危及生命的场景，探究受试者的态度：分别为患有重度智力与多重残疾（PIMD）的儿童，以及患有1型脊髓性肌萎缩症（SMA）的婴儿。结果：本次调查的参与率为55%（52/95）。参与本次调查的医师达成共识，倾向于采用无创通气与舒缓治疗，并避免实施气管切开术及有创通气。针对重度智力与多重残疾（PIMD）儿童，61%的受试者反对实施心肺复苏（CPR）；针对1型脊髓性肌萎缩症（SMA）婴儿，该比例为51%。拥有20年以上临床经验的医师，较经验较少的同行，显著更倾向于反对实施心肺复苏（CPR）。结论：医师们对此持有不同观点，且该观点受个人因素影响。这凸显了针对此类复杂临床情境，制定标准化多学科处置流程的重要性。