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

OBJECTIVE

To describe the clinical characteristics and outcomes of pediatric patients undergoing palliative extubation (PE) and identify factors associated with in-hospital death.

METHODS

This retrospective cohort study included pediatric patients who underwent PE between April 2014 and May 2023. Demographic and clinical variables were assessed, including diagnosis, duration of mechanical ventilation, time between decision-making and extubation, timing and location of extubation, medications used, catecholamine use before extubation, symptoms, treatments instituted, and hospital outcome. Descriptive and comparative analyses were performed according to hospital outcome. Time to outcome was evaluated using Kaplan-Meier survival analysis, with comparisons by the log-rank test.

RESULTS

Forty-one patients were included, with a median age of 2.67 years; 51.2% were male, and 90% had neurological impairment secondary to the underlying disease. Most patients underwent PE in the intensive care unit; 73.2% had endotracheal tubes, and 68.3% died in hospital. Median mechanical ventilation duration was 24 days; median time between decision-making and extubation was 1 day; and median time from PE to in-hospital death was 31.2 hours. Symptoms after extubation were less frequent among patients receiving opioids and/or benzodiazepines before extubation (p=0.07). The main symptoms were dyspnea and pain. Dyspnea and opioid use after extubation were associated with in-hospital death. Time to death was shorter among patients receiving catecholamines within 72 hours before PE or morphine and/or benzodiazepines after extubation.

CONCLUSIONS

This study provides clinical and epidemiological information on pediatric PE. Findings should be interpreted cautiously given the small sample size.