Extubação paliativa em pediatria: experiência de 10 anos em um hospital público de Minas Gerais

Abstract

Introduction: The removal of invasive ventilatory support, known as palliative extubation, is a measure that can bring comfort and allow incurable and irreversible diseases to follow their natural course, in line with the care objectives defined with the patient and/or family. Objectives: To present a descriptive analysis of a series of cases of pediatric patients who underwent palliative extubation between April 2014 and May 2023 in a public pediatric hospital. Results: In the original article, 41 patients, with a mean age of 4.5 years, underwent palliative extubation. About 78% of extubations were performed in the ICU, and the total duration of mechanical ventilation ranged from 2 days to 6 years. Twenty-eight (68.3%) patients died in the hospital. The occurrence of dyspnea after palliative extubation was correlated with a higher probability of in-hospital death, and the time to death was shorter among patients who received amines in the 72 hours prior to the procedure or who used morphine or benzodiazepines after the procedure. The time between removal of mechanical ventilation and hospital death ranged from 2 minutes to 25 days (median: 31.2 hours). Among the 28 patients who received opioids and/or benzodiazepines before extubation, 32% had symptoms of dyspnea, pain, or agitation, compared with 62% among those who did not receive them. The main symptoms observed were dyspnea and pain, and the main medications used to control symptoms were opioids and benzodiazepines. Conclusion: Palliative extubation is a practice with the potential to alleviate suffering and respect individual and family preferences when conducted by an experienced team with detailed planning. Greater attention to symptom control is needed, since the occurrence of dyspnea after palliative extubation was correlated with a higher probability of in-hospital death, and death occurred more quickly in patients who used vasoactive amines up to 72 hours before palliative extubation.