Implementation of Polish guidelines on futile therapy protocols in pediatric intensive care units: a multicenter retrospective review

The futile therapy protocol (FTP) is a formal document supporting decisions to withdraw or withhold certain forms of treatment owing to their futility, with the only motivation being the good of the patient, considered individually for each patient. We conducted a multicenter retrospective review of consecutive FTP cases initiated in six Polish pediatric intensive care units (PICUs) between August 2021 and June 2025. Of 227 identified cases, 25 were excluded due to substantial missing data (> 50% missing variables) or because the protocol was ultimately not implemented. Finally, 202 patients were included in the analysis. The primary outcomes were in-hospital status (death vs. discharge alive) and continuation of mechanical ventilation after futile therapy protocol (FTP) implementation (1 = continued; 0 = not continued / palliative or spontaneous breathing). Discharge destination (hospice care or Pediatric Home Mechanical Ventilation Program) was recorded when available. The median age was 24 months, and 42.8% of patients were ≤ 1 year of age, including > 70% in the first month of life. Neurological (54.3%) and oncological diseases (16.6%) were the most frequent underlying diagnoses documented in the medical records. Median time from FTP completion to death was 6 days among 60 in-hospital deaths with complete date information. Overall, 40.6% of patients were discharged alive, either to hospice care or to the Pediatric Home Mechanical Ventilation Program. Compared with patients discharged alive, those who died in hospital were younger (p = 0.005) and more likely to have chronic diseases (p < 0.001). In exploratory multivariable logistic regression, younger age and non-neurological underlying disease were independently associated with continuation of mechanical ventilation after FTP implementation. The guidelines implemented in the participating centers provided a structured framework for decision-making regarding the discontinuation of futile therapies. FTPs were most frequently initiated in children under 1 year of age with severe underlying chronic disease. A substantial proportion of patients (40%) were discharged alive to hospice care or a home mechanical ventilation program. This highlights the role of organized palliative pathways in this setting.