Improving end-of-life care in the pediatric intensive care unit

The decision to forgo life-sustaining treatment is made for 20–55% of terminally ill children in North American and European pediatric intensive care units (PICUs) [1–3]. The management of children at the end of life (EOL) can be divided into three steps. The first concerns the decisionmaking process. The second concerns the actions taken once a decision has been made to forgo life-sustaining treatments. The third regards the evaluation of the decision and its implementation. Several guidelines have been published on these different steps [4,5]. However, each step raises its share of controversies and presents tremendous opportunities to improve EOL care in the PICU.