Compassionate extubation in children at hospice and home

Abstract

At Leeds Paediatric Intensive Care Unit (PICU), whenever possible, patients are offered the opportunity to have mechanical ventilation withdrawn at a children's hospice or in the home. The aims of this study were to examine the views of the PICU staff regarding this choice, to understand their emotional and practical considerations, and to gain insight into the perceived effect on parents. An anonymous open-ended questionnaire and a focus group session invited comments from the multidisciplinary staff on the palliative care service, the options for the child to die outside the PICU, and the practical and emotional effects on themselves and the parents. Several major themes were identified: providing an appropriate environment for death in the PICU itself, parental choice, practical issues of transferring a dying child, emotional issues, service organization, and feedback from families. Overall, the staff thought that parents benefit from the choices offered. The PICU seems to fit neither the 'consultative model' nor the 'integrative model' of previous literature, but rather a 'facilitative model' not previously described.