Aspectos bioéticos de la extubación paliativa dentro de los cuidados de fin de vida en el paciente no recuperable en la UCI

Abstract

Palliative, compassionate or terminal extubation are terms that are being included more and more frequently in hospital institutions and particularly in intensive care units (ICU). JustificationThe limited number of ICU beds in the world, the oldest age of the population and greater survival in acute disease, make there are more and more situations in those that require end-of-life decisions; in patients unable to make decisions and different positions in front of the artificial vital supports installed. Problem statementICUs that have not used palliative extubation within their strategies for reorienting the therapeutic effort or that they are initiating the culture of palliative sedation and end-of-life care, face the need for a review comprehensive subject matter and generate reflections on extubation due to compassion in the ICU. MethodologyLiterature review and analysis from a bioethical perspective. Results and discussionTerminal extubation appears as a strategy to avoid prolonging unnecessarily life in non-recoverable patients and as a measure to alleviate the suffering, in cases where there is no benefit from continuing invasive ventilatory support. The COVID-19 pandemic also generates another series of tensions to include, since it is necessary to avoid prolong life support in patients with unrecoverable conditions and who are no longer they benefit from being in the ICU due to the futility of the therapies; but it is known that the removal of the orotracheal tube creates a risk of aerosols, which can lead to increased exposure for the health personnel of the SARS-CoV-2 virus.