Palliative extubation: case analysis in an Intensive Care Unit

DOI: 10.15343/0104-7809.20174103385394

Abstract

Current technological advancements have allowed for the prolongation of the dying process, especially in Intensive
Care Units (ICU). This has increased the need for decisions on the limitation of therapeutic effort (LTE), such as the use
of palliative extubation that, although difficult from an emotional standpoint, has legal and ethical justifications, and has
increased family acceptance. The objective was to evaluate the clinical and demographical profile of patients submitted
to palliative extubation (PT) in the ICU of the University Hospital of the Universidade Federal de Santa Catarina (HU/
UFSC), Brazil. This was a historical cohort whose data were obtained from forms filled out by critical care doctors from
the Hospital Death Commission at the HU/UFSC. Patients submitted to LTE that died between January 2011 and
December 2014 were included in the study. The use of PT and clinical and epidemiological data were collected. LTE
was indicated in 374 (53.8%) patients, with 23 (6.1%) receiving PT. Average age of patients undergoing PT was 73.8
years; 10 patients were over 60, and 9 were over 80 years of age. Ten (43.4%) patients had been previously in the ICU.
The average time from checking in at the ICU and extubation was 4.4 days, and between extubation and death it was
2.5 days. Neurological disease was the main cause of death of patients subjected to PT. All family members were aware
of the extubation. Family members from 2 families witnessed the extubation. Morphine was the most common analgesic
prescribed. It is concluded that patients submitted to PT were older, with neurological diseases, and the average time
from extubation to death was 2.5 days