Abstract
Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile. In consultation with the family, nursing staff, physicians, and the ethics committee, and following protocol guidelines, arrangements were made for this infant and his parents to be transported home. Once comfortable with his family, a small amount of lorazepam was given and the endotracheal tube removed. The infant died quietly about 20 minutes later. This case prompted the authors to review the current state of published articles covering this topic, suggest a protocol for implementing home extubation, realize imposed barriers, and discuss potential solutions. A well-developed plan for home extubation procedures may improve interactions with PICU and hospice services and at the same time provide additional choices for parents and patients wishing to maximize end-of-life quality outside the hospital setting.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 224-228 |
| Number of pages | 5 |
| Journal | American Journal of Hospice and Palliative Medicine |
| Volume | 23 |
| Issue number | 3 |
| DOIs | |
| State | Published - May 2006 |
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Keywords
- Barriers
- Home extubation
- Intensive care
- Pediatric hospice
ASJC Scopus subject areas
- Medicine(all)
Cite this
Home pediatric compassionate extubation : Bridging intensive and palliative care. / Zwerdling, Theodore; Hamann, Kevin C.; Kon, Alexander A.
In: American Journal of Hospice and Palliative Medicine, Vol. 23, No. 3, 05.2006, p. 224-228.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Home pediatric compassionate extubation
T2 - Bridging intensive and palliative care
AU - Zwerdling, Theodore
AU - Hamann, Kevin C.
AU - Kon, Alexander A.
PY - 2006/5
Y1 - 2006/5
N2 - Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile. In consultation with the family, nursing staff, physicians, and the ethics committee, and following protocol guidelines, arrangements were made for this infant and his parents to be transported home. Once comfortable with his family, a small amount of lorazepam was given and the endotracheal tube removed. The infant died quietly about 20 minutes later. This case prompted the authors to review the current state of published articles covering this topic, suggest a protocol for implementing home extubation, realize imposed barriers, and discuss potential solutions. A well-developed plan for home extubation procedures may improve interactions with PICU and hospice services and at the same time provide additional choices for parents and patients wishing to maximize end-of-life quality outside the hospital setting.
AB - Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile. In consultation with the family, nursing staff, physicians, and the ethics committee, and following protocol guidelines, arrangements were made for this infant and his parents to be transported home. Once comfortable with his family, a small amount of lorazepam was given and the endotracheal tube removed. The infant died quietly about 20 minutes later. This case prompted the authors to review the current state of published articles covering this topic, suggest a protocol for implementing home extubation, realize imposed barriers, and discuss potential solutions. A well-developed plan for home extubation procedures may improve interactions with PICU and hospice services and at the same time provide additional choices for parents and patients wishing to maximize end-of-life quality outside the hospital setting.
KW - Barriers
KW - Home extubation
KW - Intensive care
KW - Pediatric hospice
UR - http://www.scopus.com/inward/record.url?scp=34547251052&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34547251052&partnerID=8YFLogxK
U2 - 10.1177/1049909106289085
DO - 10.1177/1049909106289085
M3 - Article
C2 - 17060283
AN - SCOPUS:34547251052
VL - 23
SP - 224
EP - 228
JO - American Journal of Hospice and Palliative Medicine
JF - American Journal of Hospice and Palliative Medicine
SN - 1049-9091
IS - 3
ER -