Society of Critical Care Medicine 2026 Guidelines on the Care and Management of Pediatric and Neonatal Intensive Care Patients at the End of Life.
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Derrington Sabrina, Broden Arciprete Elizabeth G, Lin Matthew C, Oczkowski Simon J W, Alladin Amanda, Anani Uchenna E, Borchik Amanda K, Collins Cassandra A, Delgado-Corcoran Claudia, Dickerman Mindy J, Harrod Christopher G, Henner Natalia, Kon Alexander A, Lewis-Newby Mithya, Lord Blyth T, Masters Ashley-Anne, McCarthy Sarah, Moynihan Katie M, Munoz-Blanco Sara M, Rissman Lauren, Roberts Kathryn E, Schlegel Amy B, Schopen Ashleigh, Siegel Linda B, Swasey Harriett, Wawrzynski Sarah E, Zorko David J, DeCourcey Danielle D
Аннотация
OBJECTIVES: To develop and provide evidence-based recommendations for EOL care and management of critically ill neonatal and pediatric patients and their families.
DESIGN: The American College of Critical Care Medicine Board convened a 21-member multidisciplinary panel of experts in pediatric critical care medicine, nursing, neonatology, psychology, spiritual care, social work, child life, respiratory care, bioethics, cardiology/cardiac intensive care, palliative care, and bereaved parents. The panel included two expert methodologists specialized in developing evidence-based recommendations in alignment with the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) methodology. Conflict-of-interest policies were followed during all phases of guidelines development including task force selection and voting.
METHODS: The panel members identified and formulated five Population, Intervention, Comparator, and Outcome questions. We conducted a systematic review of literature (2000-2025) for each question to identify best available evidence, then statistically analyzed and assessed the certainty of evidence using the GRADE methodology. We used the GRADE evidence-to-decision framework to formulate the recommendations.
RESULTS: The panel generated five conditional recommendations and one good practice statement, focused on advance care planning, pediatric palliative care consultation and education, systematic symptom management, bereavement support, and health equity in EOL care.
CONCLUSIONS: The recommendations were derived from the best available evidence at time of publication and provide valuable guidance to support EOL care for PICU and neonatal ICU patients and their families.