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Resume Objectifs La loi Leonetti de 2005 est venue encadrer des procedures de limitation et d’arret de traitements de maintien des fonctions vitales (LAT) pratiquees depuis longtemps par les reanimateurs (Loi no 2005-370 du 22 avril 2005 relative aux droits des malades et a la fin de vie.) Les recommandations des societes savantes encouragent les equipes a evaluer leurs pratiques. C’est inspires du document de la commission ethique de la Societe de reanimation de langue francaise (SRLF) que nous avons realise une evaluation des pratiques de la transcription de nos decisions de LAT. Type d’etude Evaluation retrospective des pratiques sous une forme originale d’etude avant/apres une reunion d’information qui rappelait les textes de loi et les recommandations actuelles. L’etude a concerne l’ensemble des enfants ayant fait l’objet d’un questionnement de LAT (de mars 2008 a aout 2011), soit 95 enfants, dans le service de reanimation pediatrique de l’hopital Femme-Mere-Enfant de Lyon. L’analyse comprenait le recueil des donnees epidemiologiques ainsi qu’une evaluation de la transcription de nos procedures de LAT dans nos dossiers. Patients et methodes L’evaluation des pratiques a porte sur 40 dossiers. Une reunion d’information a ete realisee en janvier 2011 : 20 dossiers ont ete tires au sort avant cette date puis compares aux 20 dossiers survenus consecutivement apres la reunion. Le critere d’evaluation principal etait l’amelioration du taux de respect de chaque critere tire de la demarche d’evaluation publiee par la SRLF en janvier 2010 et adapte a la pratique pediatrique. Resultats principaux Nos donnees epidemiologiques sont comparables aux donnees de la litterature et l’evaluation de nos pratiques a servi a mettre une tendance a l’amelioration avec certains points a ameliorer : manque de details dans l’argumentation des decisions, evaluation de la douleur encore imparfaite. Il n’y pas cependant de significativite statistique. Conclusion L’evaluation des pratiques professionnelles est recommandee pour ameliorer les procedures de LAT, qui sont devenues un domaine d’expertise a part entiere en reanimation.

Leonetti Law of 2005 concerns procedures for questioning about the appropriateness of initiating or maintaining life-sustaining treatments. Decision of withdrawing and withholding treatment has long been practiced by neonatologists, adult and pediatricians intensivists. In this regard, the recommendations of societies encourage medical teams to assess their practices to improve them. Our evaluation is based on the document of the Ethics Committee of SRLF edited in 2010.We achieved a retrospective evaluation of professional practices of the transcription of our decisions of withdrawing and withholding treatment.This study included all children (95 patients) who have had a questioning about life-sustaining treatment of ICU between March 2008 and August 2011 in the pediatric intensive care unit of Children's Hospital of Lyon. Our evaluation is based on the document of the Ethics Committee of French Society of intensive care (SRLF) edited in 2010. We collected epidemiological data on children concerned by questioning about the appropriateness of initiating or maintaining LST and an evaluation of the transcription of our procedures for LST in our folders. Evaluation included 40 cases: 20 folders randomly selected prior an information meeting (January 2011) which were compared with 20 cases occurred consecutively after this information. This meeting was intended to remind recommendations of good practice and principal points of the law. The main assessment measure was the improvement of the practices respecting criteria of the document of the Ethics Committee of SRLF modified for pediatric care.Epidemiological data on procedures are comparable to literature data. Concerning the evaluation of our practices before/after a briefing and highlighted a tendency to the improvement without statistically significance. The transcription of reflection and the arguments of decision of withdrawing and withholding treatment and evaluation of pain was the points who need improvement. Finally, despite the positive developments in the therapeutic use of analgesics and sedatives, pain continues to be undervalued.The evaluation of professional practices is recommended to improve the procedures of questioning about life-sustaining treatments have become an area of expertise in intensive care.