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

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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. Biological sciences/Cancer Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Oncology futile therapy end of life children intensive care palliative care Figures Figure 1 INTRODUCTION The refusal to accept the failure of therapy and the death of the patient lead to the progressive process of medicalization of death. Social and cultural changes and advances in medicine have resulted in the fact that the most common place to end life in Poland is the intensive care unit. Unfortunately, this problem also, and perhaps especially, concerns pediatric patients. The death of a child is always shocking and devastating. Curing a sick child has become one of the most important challenges in medicine, and the doctor no longer works for the good of the patient but fights the disease, very often in vain. In many cases, parents are unable to come to terms with the death of their child, and some of them unknowingly make the dying child suffer by exerting various pressures on the medical team, who is convinced that they are doing it for the child’s sake (1). Futile therapy (FT) refers to treatment that maintains organ function without providing any benefits to the patient and without supporting the assumed therapeutic goals. FT, which prolongs the process of dying, is associated with the suffering of patients and their families and is a violation of human dignity (2). In Poland, attempts to discontinue FT have been ongoing since 2011, when a group of experts associated with a pediatric hospice drew strong attention to the need to withdraw or withhold futile therapy in children (3). This document was not accepted by the medical community and was passed over in silence by society. Over the following years, progress and access to advanced life-saving procedures in intensive care units significantly intensified the problem of decision-making and rationalized the use of all possible measures for each patient. The recommendations for the discontinuation of persistent life-sustaining treatment (LST) were published by specialists in anesthesiology and intensive care of adults (2014) (4), neonatologists (2019) (5), and pediatric intensive care unit (PICU) specialists (2022) (1). On the basis of the position of the appointed team of experts, the Patient Ombudsman issued a publication on the implementation of the patient’s right to a dignified death, containing standards for end-of-life medical therapies (2021) (6). The latest Polish document extensively discussing end-of-life medical care is the position of the Polish Society of Internal Medicine Working Group on medical futility in internal medicine units (7). This protocol aims to formally discontinue advanced treatments when they no longer provide any benefits and supports the transition of patients to palliative care. Before the protocol is implemented, specialist consultations related to the underlying condition, as well as multidisciplinary consultations, must be carried out. 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. Specifically, we sought to identify the age and disease groups in which futile therapies were applied, determine which treatments were discontinued, and assess patient survival outcomes. This study is a continuation of an earlier pilot project involving only 3 centers (9). METHODS We conducted a retrospective analysis of futile therapy protocols (FTPs) signed at six main academic pediatric intensive care units (PICUs) in Poland. We analyzed clinical cases for which the FTPs were prepared. A designated individual at each of the hospitals gathered detailed data from the protocols, including demographic information, medical history, and the patient's clinical status at the time the protocol was signed. We defined the exact duration of the disease and introduced the concept of "normal life", although it is subjective and varies greatly depending on cultural, social, and individual perspectives. We have defined it here as the absence of chronic illness before hospitalization and lack of hospitalization due to serious diseases. The data also included details of respiratory support—continuation or withholding of mechanical ventilation. The endpoint was patient survival (patient transferred to hospice care) or death. Data were collected using an Excel spreadsheet and analyzed statistically. We used descriptive statistics to summarize the study population. Categorical variables are presented as counts and percentages (n, %), and continuous variables are presented as medians with interquartile ranges (IQRs). Fisher's exact test was used to compare categorical variables. Monte Carlo simulation was applied for contingency tables larger than 2×2 (B = 10,000). For continuous variables, we used the Wilcoxon rank-sum test (for two groups) or the Kruskal–Wallis test (for more than two groups).We also performed subgroup analyses limited to in‑hospital deaths occurring more than four days following implementation of the futile therapy protocol. All the statistical tests were two-sided, and a p value < 0.05 was considered statistically significant. Analyses were conducted using R, version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria). The study design was approved by the Ethics Committee of the Medical University of Lublin (KE/651/07/2024). There was a retrospective study -the requirement for informed consent was formally waived by Committee of the Medical University of Lublin (KE/651/07/2024). The study was not a medical experiment and did not involve human participants. We confirm that all methods were performed in accordance with the relevant guidelines and regulations. RESULTS This study included 202 patients treated at 6 centers in Poland (Table 1). The median age was 24 months (IQR: 1–120); 42.8% were children up to 1 year of age, including over 70% in the first month of life (Fig. 1); and male patients predominated (58.9%). 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. Almost half of the patients (42.7%) had multiple organ failure. The suspicion of futile therapy was most often raised by anesthesiologists/intensivists (58.9%). After discontinuation of futile therapy, mechanical ventilation was continued in almost half of the patients, whereas the rest breathed spontaneously; this function was dependent on the underlying disease (Table 2). The median length of survival from preparing the protocol was 6 days (on the basis of available data for 60 patients who died in hospital). As many as 40.6% of patients were discharged either to hospice care or Pediatric Home Mechanical Ventilation Program. 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 (Tables 3 and 4). Survival duration after preparing for the FT discontinuation protocol was not dependent on the underlying disease (Table 5). DISCUSSION Withdrawal of life-sustaining treatment (WLST) for some seriously ill children was first described in the 1970s (10) and has manifested in different ways related to multiple factors, including physician, patient, culture, geography, economics, laws, religion, religiosity, and ethics education (11). In Poland, discussions on this topic began several years ago, and there is still a need for clear policies and guidance to support transparent decision-making. Most of the analyzed FT discontinuation protocols involved patients who had underlying chronic diseases, which is consistent with data from other countries (11-13). Several studies have shown that children who die after the decision to withdraw or limit treatment are more likely to have chronic diseases (14,15). Children with chronic critical illness (CCI) are high-risk patients with persistent multiple-organ dysfunction and functional morbidities requiring recurrent or prolonged critical care. The current definitions of the pediatric CCI, while variable and often subjective, form the basis for a more precise definition of the patient population based on the examination of factors related to complexity and chronicity (including prolonged PICU length of stay and hospital readmission) (16). Our study revealed that most of the analyzed protocols were related to neonates. Decisions made during this early clinical stage are critical for planning ongoing care (pediatric advance care plans). Perinatal palliative care (PPC) is an increasingly important option for pregnant women carrying fetuses with life-limiting conditions who choose to continue their pregnancies (17). As a multidisciplinary and holistic approach to care, PPC aims to minimize suffering and enhance quality of life, respecting the family’s values and preferences (18). An increasing number of these deaths follow a decision to withdraw or limit life-sustaining treatment, highlighting the importance of a clear, coordinated approach to palliative care in neonates (19). Half of our patients were not intubated, or it was decided that mechanical ventilation would be a futile therapy, or non-invasive ventilation was used, or the patients remained respiratory efficient. In Poland, we do not perform extubation or disconnect mechanical ventilation (except when death has been pronounced) before death. The use of mechanical ventilation is usually associated with multiorgan failure and the inability to transfer the patient to hospice care. The decision not to intubate the patient seems to be crucial in Polish clinical conditions in relation to futile therapy. This decision is often tantamount to refusing admission to the intensive care unit and allowing the patient to die naturally while providing palliative care. Withdrawing catecholamines, blood transfusions, renal replacement therapy, or withholding intubation and mechanical ventilation may help to avoid prolonging death. The survival time of the analyzed patients after discontinuation of futile therapy is comparable to that reported in most available studies (20) but shorter than that reported in our pilot study (9), which may be due to differences in the profile and internal policy of the hospital ward regarding patient qualification. According to the literature, 40% of patients are discharged to hospice care after the discontinuation of futile therapy. Saving invasive, burdensome procedures and therapies can not only improve the quality of life but also provide patients with a chance for a longer life. This fact has been confirmed by worldwide observations (11,12,21). Optimal end-of-life care is based on the principles of palliative medicine. The World Health Organization defines palliative care as measures aimed at improving the quality of life of patients and their relatives who face a terminal disease. Its goal is to provide patients with benefits without physical, mental, or spiritual suffering (22). Patient well-being has become the main goal of therapy (23). In Poland, in most cases, the intensivist/anesthesiologist is the first specialist to raise the suspicion of futile therapy (8,24). Nevertheless, the previously cited Polish guidelines of the Neonatal and Internal Medicine Societies allow us to assume that this trend will change in favor of minimizing FT. Proper and empathetic communication with the patient's family, especially the child's family, plays an important role. Shared decision-making involves a collaborative partnership of the health care team, parents, and the child. This process requires regular and consistent communication between team members and parents to identify the child’s best interest and alleviate parental anxiety (25). Effective communication with parents and fostering mutual trust are crucial for ensuring that decisions align with the best interests of the child. Parental involvement varies across countries. For example, a study from Slovenia has shown that only 26% of intensivists agree that a child’s legal guardian should participate in end-of-life care decisions (26). In contrast, a study from Belgium reported that physicians consulted parents regarding end-of-life decisions in 84% of cases involving the deaths of neonates and infants (27). Although according to Polish guidelines, parental consent is not needed, in practice, if both parents oppose the FTP, we do not proceed with preparing the protocol. Therefore, we did not analyze the opinions of parents in this study. It seems that we should go to court in cases of parental refusal to discontinue FT when it flagrantly violates the best interests of the child. The limitations of our study include the lack of analysis of the survival time of patients discharged to palliative care and the exact cause of death of patients remaining in the hospital ward. Another limitation is the incomplete data on the life expectancy of patients after the FTP was prepared. Future studies require continued prospective observation with the participation of other PICUs in Poland. CONCLUSIONS The guidelines implemented in the study centers facilitated decision-making regarding the discontinuation of FT. In these centers, FTPs were 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. Declarations Competing interests The author(s) declare no competing interests Funding This study was not funded. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article. Ethics declarations The study design was approved by the Ethics Committee of the Medical University of Lublin (KE/651/07/2024). Data availability https://data.mendeley.com/datasets/5r8gr3rrmv/1 References Bartkowska-Sniatkowska A, Byrska-Maciejasz E, Cettler M, Damps M, Jarosz K, Mierzewska-Schmidt M, Migdal M, Ozóg-Zabolska I, Piotrowski A, Rawicz M, Swider M, Talalaj M, Zielinska M. Guidelines regarding ineffective maintenance of organ functions (futile therapy) in paediatric intensive care units. Anaesthesiol Intensive Ther. 2021;53(5):369-375. doi: 10.5114/ait.2021.111451. PMID: 35100794; PMCID: PMC101729581 Boloz W, Krajnik M et al. The definition of overzealous therapy. The consensus of the Polish Working Group of the End-of-Life Ethics. Adv Palliat Med 2008;7:77–8 Dangel T, Grenda R, Kaczkowski J et al. Zaniechanie i wycofanie sie z uporczywego leczenia podtrzymuja?cego _zycie u dzieci. Wytyczne dla lekarzy. Polskie Towarzystwo Pediatryczne, Warszawa, 2011 Kubler A, Siewiera J, Durek G et al. Guidelines regarding the ineffective maintenance of organ functions (futile therapy) in ICU patients incapable of giving informed statements of will. Anaesthesiol Intensive Ther 2014;46:229–34 Zalecenia Polskiego Towarzystwa Neonatologicznego. Standardy opieki medycznej nad noworodkiem w Polsce, 2019 Stanowisko Zespolu powolanego przy Rzeczniku Praw Pacjenta ds. opracowania standardów postepowania w terapiach medycznych stosowanych w okresie konczacego sie zycia. Warszawa, 2021 Szczeklik W, Krajnik M, Pawlikowski J et al. Avoiding medical futility in patients dying in a hospital: a position statement of the Polish Society of Internal Medicine Working Group on Medical Futility at Internal Medicine Units. Part 1: A dying patient who is not legally incapacitated but is incapable of making informed decisions regarding treatment that is considered medically futile. Pol Arch Intern Med. 2023 Sep 29;133(9):16567. doi: 10.20452/pamw.16567. Epub 2023 Sep 21. PMID: 37733218. Damps M, Gajda M, Wiktor L, Byrska-Maciejasz E, Rybojad B et al. Opinion of Polish doctors on the use of futile therapy. Eur J Public Health. 2025 Apr 1;35(2):201-208. doi: 10.1093/eurpub/ckae202. PMID: 39707019; PMCID: PMC11967861 Damps M, Rybojad B, Bartkowska-Sniatkowska A, Aftyka A. Futile therapy protocols: A 3-year review of the implementation of Polish guidelines on ineffective organ function maintenance in pediatric intensive care unit-A pilot study. BMC Palliat Care. 2025 Apr 25;24(1):114. doi: 10.1186/s12904-025-01756-9. PMID: 40281487; PMCID: PMC12023464. Duff RS, Campbell AGM. Moral and ethical dilemmas in the special-care nursery.N.Engl.J.Med.1973;289:890-4 Benbenishty J, Ganz FD, Lautrette A, Jaschinski U, Aggarwal A et al.Variations in reporting of nurse involvement in end-of-life practices in intensive care units worldwide (ETHICUS-2): A prospective observational study. Int J Nurs Stud. 2024 Jul;155:104764. doi: 10.1016/j.ijnurstu.2024.104764. Epub 2024 Apr 11. PMID: 38657432 Lobo SM, De Simoni FHB, Jakob SM, Estella A, Vadi S, Bluethgen A, Martin-Loeches I, Sakr Y, Vincent JL; ICON investigators. Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective. Chest. 2017 Aug;152(2):321-329. doi: 10.1016/j.chest.2017.04.176. Epub 2017 May 5. Erratum in: Chest. 2021 Oct;160(4):1576-1577. doi: 10.1016/j.chest.2021.08.054. PMID: 28483610. Park SY, Phua J, Nishimura M, Deng Y, Kang Y et al. Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group. End-of-Life Care in ICUs in East Asia: A Comparison Among China, Korea, and Japan. Crit Care Med. 2018 Jul;46(7):1114-1124. doi: 10.1097/CCM.0000000000003138. PMID: 29629982 Garros D, Rosychuk RJ, Cox PN. Circumstances surrounding end of life in a pediatric intensive care unit. Pediatrics. 2003 Nov;112(5):e371. doi: 10.1542/peds.112.5.e371. PMID: 14595079 Kipper DJ, Piva JP, Garcia PC, Einloft PR, Bruno F et al. Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil. Pediatr Crit Care Med. 2005 May;6(3):258-63. doi: 10.1097/01.PCC.0000154958.71041.37. PMID: 15857521 Zorko D, McNally JD, Rochwerg B, Pinto N, Couban R, O'Hearn K, Choong K. Pediatric Chronic Critical Illness: Protocol for a Scoping Review. JMIR Res Protoc. 2021 Oct 1;10(10):e30582. doi: 10.2196/30582. PMID: 34596576; PMCID: PMC8520133. Schafer R, LoGiudice JA, Hargwood P, Wilpers A. The Role of Midwives in US Perinatal Palliative Care: A Scoping Review. J Midwifery Womens Health. 2024 Nov-Dec;69(6):875-887. doi: 10.1111/jmwh.13664. Epub 2024 Jul 9. PMID: 38979840; PMCID: PMC11622358 Perinatal Palliative Care: ACOG COMMITTEE OPINION, Number 786. Obstetrics & Gynecology 134(3):p e84-e89, September 2019. | DOI: 10.1097/AOG.0000000000003425 Barry A, Prentice T, Wilkinson D. End-of-life care over four decades in a quaternary neonatal intensive care unit. J Paediatr Child Health. 2023 Feb;59(2):341-345. doi: 10.1111/jpc.16296. Epub 2022 Dec 10. PMID: 36495233; PMCID: PMC10107744. Moore P, Kerridge I, Gillis J, Jacobe S, Isaacs D. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature. J Paediatr Child Health. 2008 Jul-Aug;44(7-8):404-8. doi: 10.1111/j.1440-1754.2008.01353.x. PMID: 18638332. Phua J, Joynt GM, Nishimura M, Deng Y, Myatra SN et al. ACME Study Investigators; Asian Critical Care Clinical Trials Group. Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions. Intensive Care Med. 2016 Jul;42(7):1118-27. doi: 10.1007/s00134-016-4347-y. Epub 2016 Apr 12. Erratum in: Intensive Care Med. 2016 Jul;42(7):1202. doi: 10.1007/s00134-016-4365-9. PMID: 27071388 Damps M, Gajda M, Stoltny L, Kowalska M, Kucewicz-Czech E. Limiting futile therapy as part of end-of-life care in intensive care units. Anaesthesiol Intensive Ther. 2022;54(3):279-284. doi: 10.5114/ait.2022.119124. PMID: 36189906; PMCID: PMC10156502. Boratynska M. Legal and Ethical Issues of Discontinuing Futile Therapy in Children. Bialystok Legal Studies 2023 vol. 28 no. 3. doi: 10.15290/bsp.2023.28.03.06 Paprocka-Lipinska A, Damps M, Barsow S, Kosiba B. Futile therapy: a survey of Polish anaesthesiologists. Anaesthesiol Intensive Ther. 2025 Apr 15;57(1):50-58. doi: 10.5114/ait/200232. PMID: 40237530. Davidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D; American College of Critical Care Medicine Task Force 2004-2005, Society of Critical Care Medicine. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007 Feb;35(2):605-22. doi: 10.1097/01.CCM.0000254067.14607.EB. PMID: 17205007. Sklansky M. Neonatal euthanasia: moral considerations and criminal liability. J Med Ethics. 2001 Feb;27(1):5-11. doi: 10.1136/jme.27.1.5. PMID: 11233379; PMCID: PMC1733340. Provoost V, Cools F, Deconinck P, Ramet J, Deschepper R, Bilsen J, Mortier F, Vandenplas Y, Deliens L. Consultation of parents in actual end-of-life decision-making in neonates and infants. Eur J Pediatr. 2006 Dec;165(12):859-66. doi: 10.1007/s00431-006-0190-4. Epub 2006 Jun 28. PMID: 16804697. Tables Table 1 is available in the Supplementary Files section. Table 2. Respiratory system after FTP depending on the underlying and concomitant disease Primary disease/Outcome Total N=198 Continued mechanical ventilation N=99 Continued spontaneous breathing N=99 Neurological 108 (54.5%) 34 (34.3%) 74 (74.7%) Oncological 32 (16.2%) 20 (20.2%) 12 (12.1%) Prematurity 25 (12.6%) 20 (20.2%) 5 (5.1%) Severe heart defect 23 (11.6%) 16 (16.2%) 7 (7.1%) Trauma/Cardiac arrest 10 (5.1%) 9 (9.1%) 1 (1.0%) p < 0.001 (Fisher’s exact test with Monte Carlo simulation) Comorbidity/Outcome Total N=184 Continued mechanical ventilation N=92 Continued spontaneous breathing N=92 Severe neurological damage 69 (37.5%) 27 (29.3%) 42 (45.7%) Multiorgan failure 78 (42.4%) 44 (47.8%) 34 (37.0%) Chronic respiratory failure 20 (10.9%) 11 (12.0%) 9 (9.8%) Heart failure 17 (9.2%) 10 (10.9%) 7 (7.6%) p=0.147 (Fisher’s exact test with Monte Carlo simulation) Table 3. Patient outcomes vs. primary disease Outcome/Primary disease Total N =199 Neurological N=108 Oncological N=33 Prematurity N=25 Severe heart defect N=23 Trauma/Cardiac arrest N=10 Discharged to hospice 80 (40.2%) 61 (56.5%) 8 (24.2%) 5 (20.0%) 6 (26.1%) 0 (0.0%) Died in hospital 119 (59.8%) 47 (43.5%) 25 (75.8%) 20 (80.0%) 17 (73.9%) 10 (100.0%) p < 0.001 (Fisher’s exact test with Monte Carlo simulation) Table 4. Patient outcomes vs. disease duration Outcome/Duration Total N=202 Since birth N=157 For a year N=15 Half a year N=7 More than 5 years N=10 Sudden onset N=13 Discharged to hospice 82 (40.6%) 73 (46.5%) 5 (33.3%) 2 (28.6%) 1 (10.0%) 1 (7.7%) Died in hospital 120 (59.4%) 84 (53.5%) 10 (66.7%) 5 (71.4%) 9 (90.0%) 12 (92.3%) p=0.011 (Fisher’s exact test with Monte Carlo simulation) Table 5. Time from FTP to death by primary disease (> 4 days) Time from FTP/Primary disease Total N=34 Neurological N=15 Oncological N=4 Prematurity N=4 Severe heart defect N=7 Trauma/Cardiac arrest N=4 Time from FTP to death (days) 11 (7.25–20.5) 15 (10–21) 13 (7.75–21) 6 (6–6.25) 11 (9–16) 11.5 (5–24.75) p=0.119 (Kruskal‒Wallis test) Additional Declarations No competing interests reported. Supplementary Files Table1.FTPRCP.docx Cite Share Download PDF Status: Published Journal Publication published 24 Apr, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 03 Feb, 2026 Reviews received at journal 01 Feb, 2026 Reviewers agreed at journal 06 Jan, 2026 Reviews received at journal 16 Dec, 2025 Reviewers agreed at journal 12 Dec, 2025 Reviewers invited by journal 24 Nov, 2025 Editor assigned by journal 11 Nov, 2025 Editor invited by journal 25 Jul, 2025 Submission checks completed at journal 24 Jul, 2025 First submitted to journal 24 Jul, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Silesia","correspondingAuthor":false,"prefix":"","firstName":"Łukasz","middleName":"","lastName":"Wiktor","suffix":""},{"id":551655945,"identity":"1f398450-4070-49f7-94bc-15f7d874d0fe","order_by":11,"name":"Izabela Duda","email":"","orcid":"","institution":"Medical University of Silesia","correspondingAuthor":false,"prefix":"","firstName":"Izabela","middleName":"","lastName":"Duda","suffix":""}],"badges":[],"createdAt":"2025-07-22 20:53:05","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7190304/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7190304/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-026-50207-9","type":"published","date":"2026-04-24T15:59:16+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":97285169,"identity":"62011b28-06f8-469b-893a-797297d74986","added_by":"auto","created_at":"2025-12-02 17:59:59","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":295753,"visible":true,"origin":"","legend":"\u003cp\u003eLegend not included with this version.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-7190304/v1/4b9ee26448cfcc4f16d8aef3.png"},{"id":107928576,"identity":"f10e7a0b-9abc-444e-843e-38737a4c9abb","added_by":"auto","created_at":"2026-04-27 16:11:22","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":479268,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7190304/v1/d0c9d880-a6e3-4922-8ab7-87291aed3d54.pdf"},{"id":97285170,"identity":"730d2188-195d-43d3-a013-bed63b4a9a6a","added_by":"auto","created_at":"2025-12-02 17:59:59","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":26345,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.FTPRCP.docx","url":"https://assets-eu.researchsquare.com/files/rs-7190304/v1/c8a900003f3ce8e9195c8e5b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The implementation of Polish guidelines regarding ineffective maintenance of organ functions (futile therapy) in pediatric intensive care units: a four-year review","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eThe refusal to accept the failure of therapy and the death of the patient lead to the progressive process of medicalization of death. Social and cultural changes and advances in medicine have resulted in the fact that the most common place to end life in Poland is the intensive care unit. Unfortunately, this problem also, and perhaps especially, concerns pediatric patients. The death of a child is always shocking and devastating. Curing a sick child has become one of the most important challenges in medicine, and the doctor no longer works for the good of the patient but fights the disease, very often in vain. In many cases, parents are unable to come to terms with the death of their child, and some of them unknowingly make the dying child suffer by exerting various\u0026nbsp;pressures on the medical team, who is convinced that they are doing it for the child\u0026rsquo;s sake (1).\u003c/p\u003e\n\u003cp\u003eFutile therapy (FT) refers to treatment that maintains organ function without providing any benefits to the patient and without supporting the assumed therapeutic goals. FT, which prolongs the process of dying, is associated with the suffering of patients and their families and is a violation of human dignity (2). In Poland, attempts to discontinue FT have been ongoing since 2011, when a group of experts associated with a pediatric hospice drew strong attention to the need to withdraw or withhold futile therapy in children (3). This document was not accepted by the medical community and was passed over in silence by society.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOver the following years, progress and access to advanced life-saving procedures in intensive care units significantly intensified the problem of decision-making and rationalized the use of all possible measures for each patient. The recommendations for the discontinuation of persistent life-sustaining treatment (LST) were published by specialists in anesthesiology and intensive care of adults (2014) (4), neonatologists (2019) (5), and pediatric intensive care unit (PICU) specialists (2022) (1). On the basis of the position of the appointed team of experts, the Patient Ombudsman issued a publication on the implementation of the patient\u0026rsquo;s right to a dignified death, containing standards for end-of-life medical therapies (2021) (6). The latest Polish document extensively discussing end-of-life medical care is the position of the Polish Society of Internal Medicine Working Group on medical futility in internal medicine units (7). This protocol aims to formally discontinue advanced treatments when they no longer provide any benefits and supports the transition of patients to palliative care. Before the protocol is implemented, specialist consultations related to the underlying condition, as well as multidisciplinary consultations, must be carried out. 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).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study aimed to analyze the futile therapy protocols implemented over the past 4 years on the basis of documentation from six major clinical centers. Specifically, we sought to identify the age and disease groups in which futile therapies were applied, determine which treatments were discontinued, and assess patient survival outcomes. This study is a continuation of an earlier pilot project involving only 3 centers (9).\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eWe conducted a retrospective analysis of futile therapy protocols (FTPs) signed at six main academic pediatric intensive care units (PICUs) in Poland. We analyzed clinical cases for which the FTPs were prepared. A designated individual at each of the hospitals gathered detailed data from the protocols, including demographic information, medical history, and the patient\u0026apos;s clinical status at the time the protocol was signed. We defined the exact duration of the disease and introduced the concept of \u0026quot;normal life\u0026quot;, although it is subjective and varies greatly depending on cultural, social, and individual perspectives. We have defined it here as the absence of chronic illness before hospitalization and lack of hospitalization due to serious diseases. The data also included details of respiratory support\u0026mdash;continuation or withholding of mechanical ventilation. The endpoint was patient survival (patient transferred to hospice care) or death. Data were collected using an Excel spreadsheet and analyzed statistically. We used descriptive statistics to summarize the study population. Categorical variables are presented as counts and percentages (n, %), and continuous variables are presented as medians with interquartile ranges (IQRs). Fisher\u0026apos;s exact test was used to compare categorical variables. Monte Carlo simulation was applied for contingency tables larger than 2\u0026times;2 (B = 10,000). For continuous variables, we used the Wilcoxon rank-sum test (for two groups) or the Kruskal\u0026ndash;Wallis test (for more than two groups).We also performed subgroup analyses limited to in‑hospital deaths occurring more than four days following implementation of the futile therapy protocol. All the statistical tests were two-sided, and a p value \u0026lt; 0.05 was considered statistically significant. Analyses were conducted using R, version 4.3.3 (R Foundation for Statistical Computing, Vienna, Austria). The study design was approved by the Ethics Committee of the Medical University of Lublin (KE/651/07/2024). There was a retrospective study -the requirement for informed consent was formally waived by Committee of the Medical University of Lublin (KE/651/07/2024). \u0026nbsp;The study was not a medical experiment and did not involve human participants. We confirm that all methods were performed in accordance with the relevant guidelines and regulations.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eThis study included 202 patients treated at 6 centers in Poland (Table 1). The median age was 24 months (IQR: 1\u0026ndash;120); 42.8% were children up to 1 year of age, including over 70% in the first month of life (Fig. 1); and male patients predominated (58.9%). 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. Almost half of the patients (42.7%) had multiple organ failure. The suspicion of futile therapy was most often raised by anesthesiologists/intensivists (58.9%). After discontinuation of futile therapy, mechanical ventilation was continued in almost half of the patients, whereas the rest breathed spontaneously; this function was dependent on the underlying disease (Table 2). The median length of survival from preparing the protocol was 6 days (on the basis of available data for 60 patients who died in hospital). As many as 40.6% of patients were discharged either to hospice care or Pediatric Home Mechanical Ventilation Program. Patients who died in intensive care units were statistically younger (p=0.005) and more likely to have chronic diseases (p\u0026lt;0.001) than those discharged to hospice care (Tables 3 and 4). Survival duration after preparing for the FT discontinuation protocol was not dependent on the underlying disease (Table 5).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWithdrawal of life-sustaining treatment (WLST) for some seriously ill children was first described in the 1970s (10) and has manifested in different ways related to multiple factors, including physician, patient, culture, geography, economics, laws, religion, religiosity, and ethics education (11). In Poland, discussions on this topic began several years ago, and there is still a need for clear policies and guidance to support transparent decision-making. Most of the analyzed FT discontinuation protocols involved patients who had underlying chronic diseases, which is consistent with data from other countries (11-13). Several studies have shown that children who die after the decision to withdraw or limit treatment are more likely to have chronic diseases (14,15). Children with chronic critical illness (CCI) are high-risk patients with persistent multiple-organ dysfunction and functional morbidities requiring recurrent or prolonged critical care. The current definitions of the pediatric CCI, while variable and often subjective, form the basis for a more precise definition of the patient population based on the examination of factors related to complexity and chronicity (including prolonged PICU length of stay and hospital readmission) (16).\u003c/p\u003e\n\u003cp\u003eOur study revealed that most of the analyzed protocols were related to neonates. Decisions made during this early clinical stage are critical for planning ongoing care (pediatric advance care plans). Perinatal palliative care (PPC) is an increasingly important option for pregnant women carrying fetuses with life-limiting conditions who choose to continue their pregnancies (17). As a multidisciplinary and holistic approach to care, PPC aims to minimize suffering and enhance quality of life, respecting the family\u0026rsquo;s values and preferences (18). An increasing number of these deaths follow a decision to withdraw or limit life-sustaining treatment, highlighting the importance of a clear, coordinated approach to palliative care in neonates (19). Half of our patients were not intubated, or it was decided that mechanical ventilation would be a futile therapy, or non-invasive ventilation was used, or the patients remained respiratory efficient. In Poland, we do not perform extubation or disconnect mechanical ventilation (except when death has been pronounced) before death. The use of mechanical ventilation is usually associated with multiorgan failure and the inability to transfer the patient to hospice care. The decision not to intubate the patient seems to be crucial in Polish clinical conditions in relation to futile therapy. This decision is often tantamount to refusing admission to the intensive care unit and allowing the patient to die naturally while providing palliative care. Withdrawing catecholamines, blood transfusions, renal replacement therapy, or withholding intubation and mechanical ventilation may help to avoid prolonging death. The survival time of the analyzed patients after discontinuation of futile therapy is comparable to that reported in most available studies (20) but shorter than that reported in our pilot study (9), which may be due to differences in the profile and internal policy of the hospital ward regarding patient qualification.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to the literature, 40% of patients are discharged to hospice care after the discontinuation of futile therapy. Saving invasive, burdensome procedures and therapies can not only improve the quality of life but also provide patients with a chance for a longer life. This fact has been confirmed by worldwide observations (11,12,21). Optimal end-of-life care is based on the principles of palliative medicine. The World Health Organization defines palliative care as measures aimed at improving the quality of life of patients and their relatives who face a terminal disease. Its goal is to provide patients with benefits without physical, mental, or spiritual suffering (22). Patient well-being has become the main goal of therapy (23). \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Poland, in most cases, the intensivist/anesthesiologist is the first specialist to raise the suspicion of futile therapy (8,24). Nevertheless, the previously cited Polish guidelines of the Neonatal and Internal Medicine Societies allow us to assume that this trend will change in favor of minimizing FT. Proper and empathetic communication with the patient\u0026apos;s family, especially the child\u0026apos;s family, plays an important role. Shared decision-making involves a collaborative partnership of the health care team, parents, and the child. This process requires regular and consistent communication between team members and parents to identify the child\u0026rsquo;s best interest and alleviate parental anxiety (25). Effective communication with parents and fostering mutual trust are crucial for ensuring that decisions align with the best interests of the child.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eParental involvement varies across countries. For example, a study from Slovenia has shown that only 26% of intensivists agree that a child\u0026rsquo;s legal guardian should participate in end-of-life care decisions (26). In contrast, a study from Belgium reported that physicians consulted parents regarding end-of-life decisions in 84% of cases involving the deaths of neonates and infants (27). Although according to Polish guidelines, parental consent is not needed, in practice, if both parents oppose the FTP, we do not proceed with preparing the protocol. Therefore, we did not analyze the opinions of parents in this study. It seems that we should go to court in cases of parental refusal to discontinue FT when it flagrantly violates the best interests of the child.\u003c/p\u003e\n\u003cp\u003eThe limitations of our study include the lack of analysis of the survival time of patients discharged to palliative care and the exact cause of death of patients remaining in the hospital ward. Another limitation is the incomplete data on the life expectancy of patients after the FTP was prepared. Future studies require continued prospective observation with the participation of other PICUs in Poland.\u003c/p\u003e"},{"header":"CONCLUSIONS","content":"\u003cp\u003eThe guidelines implemented in the study centers facilitated decision-making regarding the discontinuation of FT. In these centers, FTPs were 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.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe author(s) declare no competing interests\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was not funded. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics declarations\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study design was approved by the Ethics Committee of the Medical University of Lublin (KE/651/07/2024).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ehttps://data.mendeley.com/datasets/5r8gr3rrmv/1\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eBartkowska-Sniatkowska A, Byrska-Maciejasz E, Cettler M, Damps M, Jarosz K, Mierzewska-Schmidt M, Migdal M, Ozóg-Zabolska I, Piotrowski A, Rawicz M, Swider M, Talalaj M, Zielinska M. Guidelines regarding ineffective maintenance of organ functions (futile therapy) in paediatric intensive care units. Anaesthesiol Intensive Ther. 2021;53(5):369-375. doi: 10.5114/ait.2021.111451. PMID: 35100794; PMCID: PMC101729581\u003c/li\u003e\n\u003cli\u003eBoloz W, Krajnik M et al. The definition of overzealous therapy. The consensus of the Polish Working Group of the End-of-Life Ethics. Adv Palliat Med 2008;7:77–8\u003c/li\u003e\n\u003cli\u003eDangel T, Grenda R, Kaczkowski J et al. Zaniechanie i wycofanie sie z uporczywego leczenia podtrzymuja?cego _zycie u dzieci. Wytyczne dla lekarzy. Polskie Towarzystwo Pediatryczne, Warszawa, 2011\u003c/li\u003e\n\u003cli\u003eKubler A, Siewiera J, Durek G et al. Guidelines regarding the ineffective maintenance of organ functions (futile therapy) in ICU patients incapable of giving informed statements of will. Anaesthesiol Intensive Ther 2014;46:229–34\u003c/li\u003e\n\u003cli\u003eZalecenia Polskiego Towarzystwa Neonatologicznego. Standardy opieki medycznej nad noworodkiem w Polsce, 2019\u003c/li\u003e\n\u003cli\u003eStanowisko Zespolu powolanego przy Rzeczniku Praw Pacjenta ds. opracowania standardów postepowania w terapiach medycznych stosowanych w okresie konczacego sie zycia. Warszawa, 2021\u003c/li\u003e\n\u003cli\u003eSzczeklik W, Krajnik M, Pawlikowski J et al. Avoiding medical futility in patients dying in a hospital: a position statement of the Polish Society of Internal Medicine Working Group on Medical Futility at Internal Medicine Units. Part 1: A dying patient who is not legally incapacitated but is incapable of making informed decisions regarding treatment that is considered medically futile. Pol Arch Intern Med. 2023 Sep 29;133(9):16567. doi: 10.20452/pamw.16567. Epub 2023 Sep 21. PMID: 37733218.\u003c/li\u003e\n\u003cli\u003eDamps M, Gajda M, Wiktor L, Byrska-Maciejasz E, Rybojad B et al. Opinion of Polish doctors on the use of futile therapy. Eur J Public Health. 2025 Apr 1;35(2):201-208. doi: 10.1093/eurpub/ckae202. PMID: 39707019; PMCID: PMC11967861\u003c/li\u003e\n\u003cli\u003eDamps M, Rybojad B, Bartkowska-Sniatkowska A, Aftyka A. Futile therapy protocols: A 3-year review of the implementation of Polish guidelines on ineffective organ function maintenance in pediatric intensive care unit-A pilot study. BMC Palliat Care. 2025 Apr 25;24(1):114. doi: 10.1186/s12904-025-01756-9. PMID: 40281487; PMCID: PMC12023464.\u003c/li\u003e\n\u003cli\u003eDuff RS, Campbell AGM. Moral and ethical dilemmas in the special-care nursery.N.Engl.J.Med.1973;289:890-4\u003c/li\u003e\n\u003cli\u003eBenbenishty J, Ganz FD, Lautrette A, Jaschinski U, Aggarwal A et al.Variations in reporting of nurse involvement in end-of-life practices in intensive care units worldwide (ETHICUS-2): A prospective observational study. Int J Nurs Stud. 2024 Jul;155:104764. doi: 10.1016/j.ijnurstu.2024.104764. Epub 2024 Apr 11. PMID: 38657432\u003c/li\u003e\n\u003cli\u003eLobo SM, De Simoni FHB, Jakob SM, Estella A, Vadi S, Bluethgen A, Martin-Loeches I, Sakr Y, Vincent JL; ICON investigators. Decision-Making on Withholding or Withdrawing Life Support in the ICU: A Worldwide Perspective. Chest. 2017 Aug;152(2):321-329. doi: 10.1016/j.chest.2017.04.176. Epub 2017 May 5. Erratum in: Chest. 2021 Oct;160(4):1576-1577. doi: 10.1016/j.chest.2021.08.054. PMID: 28483610.\u003c/li\u003e\n\u003cli\u003ePark SY, Phua J, Nishimura M, Deng Y, Kang Y et al. Asian Collaboration for Medical Ethics (ACME) Study Collaborators and the Asian Critical Care Clinical Trials (ACCCT) Group. End-of-Life Care in ICUs in East Asia: A Comparison Among China, Korea, and Japan. Crit Care Med. 2018 Jul;46(7):1114-1124. doi: 10.1097/CCM.0000000000003138. PMID: 29629982\u003c/li\u003e\n\u003cli\u003eGarros D, Rosychuk RJ, Cox PN. Circumstances surrounding end of life in a pediatric intensive care unit. Pediatrics. 2003 Nov;112(5):e371. doi: 10.1542/peds.112.5.e371. PMID: 14595079\u003c/li\u003e\n\u003cli\u003eKipper DJ, Piva JP, Garcia PC, Einloft PR, Bruno F et al. Evolution of the medical practices and modes of death on pediatric intensive care units in southern Brazil. Pediatr Crit Care Med. 2005 May;6(3):258-63. doi: 10.1097/01.PCC.0000154958.71041.37. PMID: 15857521\u003c/li\u003e\n\u003cli\u003eZorko D, McNally JD, Rochwerg B, Pinto N, Couban R, O'Hearn K, Choong K. Pediatric Chronic Critical Illness: Protocol for a Scoping Review. JMIR Res Protoc. 2021 Oct 1;10(10):e30582. doi: 10.2196/30582. PMID: 34596576; PMCID: PMC8520133.\u003c/li\u003e\n\u003cli\u003eSchafer R, LoGiudice JA, Hargwood P, Wilpers A. The Role of Midwives in US Perinatal Palliative Care: A Scoping Review. J Midwifery Womens Health. 2024 Nov-Dec;69(6):875-887. doi: 10.1111/jmwh.13664. Epub 2024 Jul 9. PMID: 38979840; PMCID: PMC11622358\u003c/li\u003e\n\u003cli\u003ePerinatal Palliative Care: ACOG COMMITTEE OPINION, Number 786. Obstetrics \u0026amp; Gynecology 134(3):p e84-e89, September 2019. | DOI: 10.1097/AOG.0000000000003425\u003c/li\u003e\n\u003cli\u003eBarry A, Prentice T, Wilkinson D. End-of-life care over four decades in a quaternary neonatal intensive care unit. J Paediatr Child Health. 2023 Feb;59(2):341-345. doi: 10.1111/jpc.16296. Epub 2022 Dec 10. PMID: 36495233; PMCID: PMC10107744.\u003c/li\u003e\n\u003cli\u003eMoore P, Kerridge I, Gillis J, Jacobe S, Isaacs D. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature. J Paediatr Child Health. 2008 Jul-Aug;44(7-8):404-8. doi: 10.1111/j.1440-1754.2008.01353.x. PMID: 18638332.\u003c/li\u003e\n\u003cli\u003ePhua J, Joynt GM, Nishimura M, Deng Y, Myatra SN et al. ACME Study Investigators; Asian Critical Care Clinical Trials Group. Withholding and withdrawal of life-sustaining treatments in low-middle-income versus high-income Asian countries and regions. Intensive Care Med. 2016 Jul;42(7):1118-27. doi: 10.1007/s00134-016-4347-y. Epub 2016 Apr 12. Erratum in: Intensive Care Med. 2016 Jul;42(7):1202. doi: 10.1007/s00134-016-4365-9. PMID: 27071388\u003c/li\u003e\n\u003cli\u003eDamps M, Gajda M, Stoltny L, Kowalska M, Kucewicz-Czech E. Limiting futile therapy as part of end-of-life care in intensive care units. Anaesthesiol Intensive Ther. 2022;54(3):279-284. doi: 10.5114/ait.2022.119124. PMID: 36189906; PMCID: PMC10156502.\u003c/li\u003e\n\u003cli\u003eBoratynska M. Legal and Ethical Issues of Discontinuing Futile Therapy in Children. Bialystok Legal Studies 2023 vol. 28 no. 3. doi: 10.15290/bsp.2023.28.03.06\u003c/li\u003e\n\u003cli\u003ePaprocka-Lipinska A, Damps M, Barsow S, Kosiba B. Futile therapy: a survey of Polish anaesthesiologists. Anaesthesiol Intensive Ther. 2025 Apr 15;57(1):50-58. doi: 10.5114/ait/200232. PMID: 40237530.\u003c/li\u003e\n\u003cli\u003eDavidson JE, Powers K, Hedayat KM, Tieszen M, Kon AA, Shepard E, Spuhler V, Todres ID, Levy M, Barr J, Ghandi R, Hirsch G, Armstrong D; American College of Critical Care Medicine Task Force 2004-2005, Society of Critical Care Medicine. Clinical practice guidelines for support of the family in the patient-centered intensive care unit: American College of Critical Care Medicine Task Force 2004-2005. Crit Care Med. 2007 Feb;35(2):605-22. doi: 10.1097/01.CCM.0000254067.14607.EB. PMID: 17205007.\u003c/li\u003e\n\u003cli\u003eSklansky M. Neonatal euthanasia: moral considerations and criminal liability. J Med Ethics. 2001 Feb;27(1):5-11. doi: 10.1136/jme.27.1.5. PMID: 11233379; PMCID: PMC1733340.\u003c/li\u003e\n\u003cli\u003eProvoost V, Cools F, Deconinck P, Ramet J, Deschepper R, Bilsen J, Mortier F, Vandenplas Y, Deliens L. Consultation of parents in actual end-of-life decision-making in neonates and infants. Eur J Pediatr. 2006 Dec;165(12):859-66. doi: 10.1007/s00431-006-0190-4. Epub 2006 Jun 28. PMID: 16804697.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\n\u003cstrong\u003eTable 1 is available in the Supplementary Files section.\u003cbr\u003e\u003c/strong\u003e\n\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRespiratory system after FTP depending on the underlying and concomitant disease\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrimary disease/Outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal\u003cbr\u003e\u0026nbsp;N=198\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eContinued mechanical ventilation\u003cbr\u003e\u0026nbsp;N=99\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eContinued spontaneous breathing\u003cbr\u003e\u0026nbsp;N=99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eNeurological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e108 (54.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (34.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74 (74.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOncological\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e32 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (12.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePrematurity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (12.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere heart defect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23 (11.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e16 (16.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (7.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTrauma/Cardiac arrest\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (5.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (9.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (1.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ep \u0026lt; 0.001 (Fisher\u0026rsquo;s exact test with Monte Carlo simulation)\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"613\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eComorbidity/Outcome\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal\u003cbr\u003e\u0026nbsp;N=184\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eContinued mechanical ventilation\u003cbr\u003e\u0026nbsp;N=92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eContinued spontaneous breathing\u003cbr\u003e\u0026nbsp;N=92\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere neurological damage\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69 (37.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27 (29.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e42 (45.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eMultiorgan failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78 (42.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44 (47.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e34 (37.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eChronic respiratory failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (12.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (9.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHeart failure\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (9.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (10.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7 (7.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ep=0.147 (Fisher\u0026rsquo;s exact test with Monte Carlo simulation)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3.\u003c/strong\u003e \u003cstrong\u003ePatient outcomes vs. primary disease\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOutcome/Primary disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal\u003cbr\u003e\u0026nbsp;N =199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNeurological\u003cbr\u003e\u0026nbsp;N=108\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOncological\u003cbr\u003e\u0026nbsp;N=33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrematurity\u003cbr\u003e\u0026nbsp;N=25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere heart defect\u003cbr\u003e\u0026nbsp;N=23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTrauma/Cardiac arrest\u003cbr\u003e\u0026nbsp;N=10\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDischarged to hospice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e80 (40.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e61 (56.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e8 (24.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (26.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDied in hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e119 (59.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e47 (43.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25 (75.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e20 (80.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e17 (73.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (100.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ep \u0026lt; 0.001 (Fisher\u0026rsquo;s exact test with Monte Carlo simulation)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Patient outcomes vs. disease duration\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eOutcome/Duration\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal\u003cbr\u003e\u0026nbsp;N=202\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSince birth\u003cbr\u003e\u0026nbsp;N=157\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFor a year\u003cbr\u003e\u0026nbsp;N=15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHalf a year\u003cbr\u003e\u0026nbsp;N=7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMore than 5 years\u003cbr\u003e\u0026nbsp;N=10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSudden onset\u003cbr\u003e\u0026nbsp;N=13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDischarged to hospice\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e82 (40.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e73 (46.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (33.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2 (28.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (10.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1 (7.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eDied in hospital\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e120 (59.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e84 (53.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10 (66.7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e5 (71.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e9 (90.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12 (92.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ep=0.011 (Fisher\u0026rsquo;s exact test with Monte Carlo simulation)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5.\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTime from FTP to death by primary disease (\u0026gt; 4 days)\u0026nbsp;\u003cbr\u003e\u003c/strong\u003e\u003c/p\u003e\n\u003cdiv\u003e\n \u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTime from FTP/Primary disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTotal\u003cbr\u003e\u0026nbsp;N=34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNeurological\u003cbr\u003e\u0026nbsp;N=15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eOncological\u003cbr\u003e\u0026nbsp;N=4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePrematurity\u003cbr\u003e\u0026nbsp;N=4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSevere heart defect\u003cbr\u003e\u0026nbsp;N=7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eTrauma/Cardiac arrest\u003cbr\u003e\u0026nbsp;N=4\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eTime from FTP to death (days)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (7.25\u0026ndash;20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15 (10\u0026ndash;21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e13 (7.75\u0026ndash;21)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e6 (6\u0026ndash;6.25)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11 (9\u0026ndash;16)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e11.5 (5\u0026ndash;24.75)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ep=0.119 (Kruskal‒Wallis test)\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"futile therapy, end of life, children intensive care, palliative care","lastPublishedDoi":"10.21203/rs.3.rs-7190304/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7190304/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"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\u003c0.001) 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.","manuscriptTitle":"The implementation of Polish guidelines regarding ineffective maintenance of organ functions (futile therapy) in pediatric intensive care units: a four-year review","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-02 17:59:54","doi":"10.21203/rs.3.rs-7190304/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-03T17:40:40+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-01T14:26:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"288350156896314116194948828123486397566","date":"2026-01-06T12:24:28+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-12-16T20:41:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"319231159909778441222775523671354805464","date":"2025-12-12T21:50:31+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-25T03:03:43+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-11-11T16:42:10+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-07-25T17:55:13+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-07-24T18:57:15+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-07-24T18:53:54+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"31d0f234-d231-4558-92ff-f956b142fe2b","owner":[],"postedDate":"December 2nd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":58703195,"name":"Biological sciences/Cancer"},{"id":58703196,"name":"Health sciences/Diseases"},{"id":58703197,"name":"Health sciences/Health care"},{"id":58703198,"name":"Health sciences/Medical research"},{"id":58703199,"name":"Health sciences/Oncology"}],"tags":[],"updatedAt":"2026-04-27T16:07:51+00:00","versionOfRecord":{"articleIdentity":"rs-7190304","link":"https://doi.org/10.1038/s41598-026-50207-9","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-04-24 15:59:16","publishedOnDateReadable":"April 24th, 2026"},"versionCreatedAt":"2025-12-02 17:59:54","video":"","vorDoi":"10.1038/s41598-026-50207-9","vorDoiUrl":"https://doi.org/10.1038/s41598-026-50207-9","workflowStages":[]},"version":"v1","identity":"rs-7190304","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7190304","identity":"rs-7190304","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}