Palliative extubation in intensive care units: scoping review.
Rafaella Guilherme Gonçalves, Lucas Batista Ferreira, Tarcísio Tércio das Neves Júnior and 3 others
PMID 41842828WHAT IT FOUND
Palliative extubation practice varies widely across ICUs, with no evidence that terminal weaning or immediate extubation is superior.
Comfort care relied on planned opioid and sedative use, family communication, and team debriefing.
Key findings
01The included evidence showed considerable variability in palliative extubation practice and a lack of robust, standardized guidelines for managing it in the ICU.
02Most patients died within 24 hours after palliative extubation, and time to death depended mainly on pre-extubation clinical severity rather than analgesia or sedation.
03Immediate extubation was associated with more respiratory events and a shorter time to death than terminal weaning, but the review found no evidence that either method is superior.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a scoping review, not a trial, so it maps what is known and does not prove that any palliative extubation method or protocol improves outcomes. The included evidence was dominated by observational studies and reviews, with only one case report, one quasi-experimental study, and one intervention study. Practice varied widely across countries and institutions, and many findings came from the United States, so local applicability may be limited. The authors excluded restricted-access articles and noted a scarcity of high-level evidence, especially for Brazilian practice. The review focused on adult ICU patients, so it does not address pediatric or home settings. Symptom measurement was heterogeneous, and the Respiratory Distress Observation Scale is not cross-culturally validated for Brazilian Portuguese.
The easy way to misread this
Do not conclude that opioid or sedative titration hastens death. The review reports that opioids and proportional sedatives did not accelerate death, and time to death depended mainly on clinical severity.