*Case 2:*

A 2-year-old with a terminal pelvic malignancy had invasion of her lumbosacral plexus and severe neuropathic pain. Standard palliative analgesic regimens had been unsuccessful. An intravenous infusion of lignocaine was commenced with some improvement in her symptoms. An intrathecal catheter was sited, and infusion of opioids with local anaesthetic provided her with greatly improved pain relief in her final days.

## *Case 3:*

A neonate with central respiratory depression, seizures and limb contractures was admitted to PICU for non-invasive ventilation. A palliative care referral was made, and gabapentin was commenced for central irritability. He was subsequently discharged to the ward.

**19**

*Palliative Care of the Infant and Child in the Paediatric Intensive Care Unit*

Communication plays a key role in the delivery of high-quality end of life care in PICU [28, 29]. In this highly technical environment, the discussion of diagnoses, interventions and prognoses must be delivered using language that the patient and

When the clinical trajectory shifts and the goals of care are realigned to focus upon comfort measures, this can be a particularly stressful and disorientating time for the family. High-quality communication during this time can reduce the risk of

As discussion shifts from procedure-oriented conversations to planning the initiation of palliative care, the PICU clinician may be out of their comfort zone [31]. Research shows that clinicians prefer to discuss technical medical issues rather than emotional issues pertaining to quality of life [32]. It is, however, important for us to recognize that by building an empathic relationship based on information sharing,

Family conferences are an essential communication platform when a child is undergoing palliative care in the PICU [34]. Members of the team and the family have the opportunity to discuss goals of care in the context of the patient's clinical condition and the family values. A trusting relationship can be built with the family and this can facilitate the transition from critical care provision to the delivery of

Although clinicians attribute considerable importance to family conferences [35], communication with the family in PICU most frequently occurs at the bedside [33]. Regardless of location, every interaction with the family is an opportunity to build trust and understanding. The team may consider appointment of one reliable point of contact, such as a specialist nurse for the family. This will facilitate relationship building with the family and provide for consistency in

The PICU team must be cognisant of the following barriers to effective communication that can exist: delivery of inconsistent messages regarding the care plan; time constraints; the stressful environment; and a deficit of communication

Communication strategies that have been shown to be improve the end of life experience for families in PICU include: participation of the family in decisionmaking; limiting the use of medical terminology; displaying honesty when a child

The delivery of palliative care to a child in PICU often represents a shift away from technical critical care interventions and cure-focused management. Emotional support and quality of life become key priorities, in addition to a focus

End of life decision-making for a child is a complex and emotional process and encouragement of a family-centred approach has been shown to result in greater family satisfaction [39]. Information sharing with the family and their participation

The medical team should pay close attention to the information needs and preferences of patients and their families [40], particularly when providing technical information within the often stressful PICU environment. Difficult conversations

has a poor prognosis and compassionately sharing family grief [38].

*DOI: http://dx.doi.org/10.5772/intechopen.97275*

stress-related disorders in the bereaved family [30].

we foster a supportive relationship with the family [33].

**3. Communication**

palliative care.

training [37].

communications [36].

**4. Family-centred care**

upon family- centred care.

in the decision-making process are both important.

family will easily understand.
