Ventilator Weaning and Terminal Extubation: Withdrawal of Life-Sustaining Therapy in Children. Secondary Analysis of the Death One Hour After Terminal Extubation Study-Reference-Cited by-同舟云学术

Ventilator Weaning and Terminal Extubation: Withdrawal of Life-Sustaining Therapy in Children. Secondary Analysis of the Death One Hour After Terminal Extubation Study

Published:2023-10-27 Issue: Volume: Page:
ISSN:0090-3493
Container-title:Critical Care Medicine
language:en
Short-container-title:

Author:

Pringle Charlene P.¹,Filipp Stephanie L.²,Morrison Wynne E.,Fainberg Nina A.³,Aczon Melissa D.⁴⁵,Avesar Michael⁶,Burkiewicz Kimberly F.⁷,Chandnani Harsha K.⁶,Hsu Stephanie C.⁸⁹,Laksana Eugene⁴⁵,Ledbetter David R.¹⁰,McCrory Michael C.¹¹,Morrow Katie R.¹²,Noguchi Anna E.¹³,O’Brien Caitlin E.¹⁴,Ojha Apoorva¹⁵,Ross Patrick A.⁴¹⁶,Shah Sareen⁵¹⁷,Shah Jui K.⁶,Siegel Linda B.¹⁸,Tripathi Sandeep⁷,Wetzel Randall C.⁴⁵¹⁶,Zhou Alice X.⁴⁵,Winter Meredith C.⁴¹⁶

Affiliation:

1. Department of Pediatrics, Critical Care Medicine, University of Florida, Gainesville, FL.

2. Department of Pediatrics, Pediatric Research Hub, University of Florida Gainesville, FL.

3. Division of Pediatric Critical Care, Children’s Hospital of Philadelphia Philadelphia, PA.

4. Department of Anesthesiology Critical Care Medicine, Children’s Hospital Los Angeles Los Angeles, CA.

5. Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA.

6. Division of Pediatric Critical Care Medicine, Loma Linda University Children’s Hospital, Loma Linda, CA.

7. Pediatric Intensive Care, OSF HealthCare, Children’s Hospital of Illinois, Peoria, IL Peoria, IL.

8. Division of Critical Care Medicine, Department of Pediatrics, Dallas, TX.

9. The University of Texas Southwestern Medical Center at Dallas, Children’s Health Medical Center Dallas Dallas, TX.

10. KPMG Lighthouse, Dallas, TX.

11. Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC.

12. Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL.

13. Program Coordinator for Organ, Eye, and Tissue Donation Johns Hopkins Hospital, Baltimore, MD.

14. Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.

15. Michigan State University College of Human Medicine, East Lansing, MI.

16. Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.

17. Division of Pediatric Critical Care, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA.

18. Division of Pediatric Critical Care Medicine, Cohen Children’s Medical Center, New Hyde Park, NY.

Abstract

Objective: Terminal extubation (TE) and terminal weaning (TW) during withdrawal of life-sustaining therapies (WLSTs) have been described and defined in adults. The recent Death One Hour After Terminal Extubation study aimed to validate a model developed to predict whether a child would die within 1 hour after discontinuation of mechanical ventilation for WLST. Although TW has not been described in children, pre-extubation weaning has been known to occur before WLST, though to what extent is unknown. In this preplanned secondary analysis, we aim to describe/define TE and pre-extubation weaning (PW) in children and compare characteristics of patients who had ventilatory support decreased before WLST with those who did not. Design: Secondary analysis of multicenter retrospective cohort study. Setting: Ten PICUs in the United States between 2009 and 2021. Patients: Nine hundred thirteen patients 0–21 years old who died after WLST. Interventions: None. Measurements and Main Results: 71.4% (n = 652) had TE without decrease in ventilatory support in the 6 hours prior. TE without decrease in ventilatory support in the 6 hours prior = 71.4% (n = 652) of our sample. Clinically relevant decrease in ventilatory support before WLST = 11% (n = 100), and 17.6% (n = 161) had likely incidental decrease in ventilatory support before WLST. Relevant ventilator parameters decreased were Fio 2 and/or ventilator set rates. There were no significant differences in any of the other evaluated patient characteristics between groups (weight, body mass index, unit type, primary diagnostic category, presence of coma, time to death after WLST, analgosedative requirements, postextubation respiratory support modality). Conclusions: Decreasing ventilatory support before WLST with extubation in children does occur. This practice was not associated with significant differences in palliative analgosedation doses or time to death after extubation.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Critical Care and Intensive Care Medicine

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