Abstract
Aims & Objectives: Compassionate extubation comprises the elective withdrawal of mechanical ventilation support and an approach to make the process as symptom-free and as well supported as possible for patients and their families. This study aimed to describe a series of cases of compassionate extubation in a pediatric intensive care unit (PICU) in Brazil. Methods: Retrospective case series. Results: Three patients underwent compassionate extubation. Age, primary diagnosis and underlying conditions at admission on PICU were: 7-month-old girl with anencephaly and pneumonia; 1-month-old girl with unfavorable complex heart disease; 7-year-old girl with untreatable metastatic neuroblastoma. After extubation, the patient with anencephaly was discharged, the oncologic patient was transferred to ward and died 2 days later, and the baby with heart disease died 1 hour later. Conclusions: Pediatric patients with life-limiting illness who are seriously ill may have different goals of care, including not prolonging the dying process and minimize suffering. In this setting, a role for pediatric palliative care specialist support and withdrawal of life-sustaining treatment is emerging. The process includes an interdisciplinary team approach, active symptoms management, setting expectations and postextubation plan of care. Ongoing survival following withdrawal of life-sustaining treatment is possible and difficult to predict.
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