Ten years of experience with pediatric palliative extubation in a Brazilian pediatric hospital: a retrospective analysis

Objective To analyze a cohort of pediatric patients who underwent palliative extubation and identify factors associated with a higher probability of in-hospital death. Method: Retrospective cohort study of pediatric patients who underwent palliative extubation between April 2014 and May 2023. Demographic variables were evaluated, including diagnosis, duration of mechanical ventilation, time between decision and extubation, time and place of extubation, medications used, use of catecholamines before extubation, symptoms, treatment instituted, and hospital outcome. A descriptive analysis, a comparative analysis of hospital outcomes, and a Kaplan-Meier survival curve were performed, with comparison using the log-rank test. Results: Forty-one patients with a mean age of 4.5 years; 51.2% male; 90% with neurological impairment secondary to underlying disease. Most patients were extubated in the Intensive Care Unit. 73.2% used endotracheal tubes; 68.3% died in hospital. Median total mechanical ventilation time: 24 days; time between decision and extubation: 1 day; time between palliative extubation and hospital death: 31.2 hours. Symptoms after extubation were less frequent among patients who received opioids and/or benzodiazepines before extubation (p=0.07). Main symptoms: dyspnea and pain, controlled with opioids/benzodiazepines. Dyspnea after extubation correlated with a higher probability of in-hospital death, and the time to death was shorter among those who received catecholamines 72 hours before or who used morphine/benzodiazepines after extubation. Conclusions: this study in a single center reinforces the importance of considering PE as a care strategy for patients with severe, incapacitating, and irreversible diseases, following the wishes and values expressed by the patient and/or their family.