Palliative Extubation Protocol

Abstract

Introduction: Palliative Extubation (PE) is considered to be the discontinuation of mechanical ventilation in patients whose death is inevitable, prioritizing comfort and respecting the patient’s wishes. This study focuses on definitions, ethical, and legal issues, as well as challenges faced by healthcare professionals.Objective: To explore PE as part of the transition in care, emphasizing symptomatic relief and continuity of PalliativeCare. A protocol and checklist for PE is proposed to guide professionals through the process.Method: Review of definitions, ethical, and legal aspects and presentation of a protocol and checklist for PE. Description of PE methods, including withdrawal of ventilatory support and the complexity of the decision.Results: The decision for PE must respect bioethical principles, patient autonomy and consider prognostic factors. The importance of analgesia and sedation is highlighted.Discussion: Ethical and legal aspects, such as Resolution 1805/2006 of the Federal Council of Medicine support PE, emphasizing the dignity of the patient and the right to therapeutic refusal. The updating of the Code of Medical Ethics in 2018 reinforces the provision of palliative care in terminal illnesses.Conclusion: PE is a complex and delicate practice in Intensive Palliative Care. The review highlights the importance of ethical and legal considerations and specific care when making decisions about PE, emphasizing quality in the dying process and relief of suffering.