Home pediatric compassionate extubation: Bridging intensive and palliative care

Theodore Zwerdling, Kevin C. Hamann, Alexander A. Kon

Research output: Contribution to journalArticle

24 Scopus citations

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 languageEnglish (US)
Pages (from-to)224-228
Number of pages5
JournalAmerican Journal of Hospice and Palliative Medicine
Volume23
Issue number3
DOIs
StatePublished - May 2006

Keywords

  • Barriers
  • Home extubation
  • Intensive care
  • Pediatric hospice

ASJC Scopus subject areas

  • Medicine(all)

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