Carolina D. Affonseca (Brazil)
Hospital Infantil João Paulo II Pediatric Intensive CareAuthor Of 1 Presentation
PALLIATIVE EXTUBATION: FIVE-YEAR EXPERIENCE IN A PEDIATRIC HOSPITAL IN BRAZIL
Abstract
Background and Aims
To evaluate the clinical and demographical characteristics of pediatric patients with chronic and irreversible diseases who went through palliative extubation.
Methods
Descriptive analysis of a case series of pediatric patients admitted in a public pediatric hospital in Brazil, with chronic and irreversible diseases, permanently dependent on ventilatory support, who went through palliative extubation between April 2014 and December 2019. The following information was collected from the medical records: demographic data, diagnosis, duration and type of mechanical ventilation; date, time, and place of palliative extubation; medications used; symptoms observed; and hospital outcome.
Results
In this 5 years experience, after the multidisciplinary team’s consensus and creation of the care plan jointly with the family, 24 patients with a mean age of 3.4 years experienced palliative extubation. 17 (70,8%) of extubations were performed in the ICU, 4 at the pediatric ward and 3 at isolated beds;16 patients (66.7%) died inside the hospital, 8 had hospital discharge. 16 patients had an orotracheal tube and the others a tracheostomy. The time between mechanical ventilation withdrawal and in-hospital death vary from 15 minutes to 54 days. The main symptoms were dyspnea, pain and agitation. The main drugs used to control symptoms were opioids and benzodiazepines.
Conclusions
Palliative extubation requires specialized care, with the presence and availability of a multidisciplinary team with adequate training in symptom control and palliative care. The present study is limited by the small sample size, which may explain why it was not possible to identify predictors of survival time after ventilatory support withdrawal.