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

Autor:	Pringle CP; Department of Pediatrics, Critical Care Medicine, University of Florida, Gainesville, FL., Filipp SL; Department of Pediatrics, Pediatric Research Hub, University of Florida Gainesville, FL., Morrison WE; Department of Pediatrics, Critical Care Medicine, University of Florida, Gainesville, FL.; Department of Pediatrics, Pediatric Research Hub, University of Florida Gainesville, FL.; Department of Anesthesiology and Critical Care, Perelman School of Medicine at the University of Pennsylvania Philadelphia, PA.; Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia Philadelphia, PA.; Division of Pediatric Critical Care, Children's Hospital of Philadelphia Philadelphia, PA.; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA.; Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, CA.; Pediatric Intensive Care, OSF HealthCare, Children's Hospital of Illinois, Peoria, IL Peoria, IL.; Division of Critical Care Medicine, Department of Pediatrics, Dallas, TX.; The University of Texas Southwestern Medical Center at Dallas, Children's Health Medical Center Dallas Dallas, TX.; KPMG Lighthouse, Dallas, TX.; Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC.; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.; Program Coordinator for Organ, Eye, and Tissue Donation Johns Hopkins Hospital, Baltimore, MD.; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD.; Michigan State University College of Human Medicine, East Lansing, MI.; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.; Division of Pediatric Critical Care, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA.; Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center, New Hyde Park, NY., Fainberg NA; Division of Pediatric Critical Care, Children's Hospital of Philadelphia Philadelphia, PA., Aczon MD; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA., Avesar M; Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, CA., Burkiewicz KF; Pediatric Intensive Care, OSF HealthCare, Children's Hospital of Illinois, Peoria, IL Peoria, IL., Chandnani HK; Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, CA., Hsu SC; Division of Critical Care Medicine, Department of Pediatrics, Dallas, TX.; The University of Texas Southwestern Medical Center at Dallas, Children's Health Medical Center Dallas Dallas, TX., Laksana E; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA., Ledbetter DR; KPMG Lighthouse, Dallas, TX., McCrory MC; Departments of Anesthesiology and Pediatrics, Wake Forest University School of Medicine, Winston Salem, NC., Morrow KR; Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL., Noguchi AE; Program Coordinator for Organ, Eye, and Tissue Donation Johns Hopkins Hospital, Baltimore, MD., O'Brien CE; Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University, Baltimore, MD., Ojha A; Michigan State University College of Human Medicine, East Lansing, MI., Ross PA; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA., Shah S; Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA.; Division of Pediatric Critical Care, Department of Pediatrics, Cedars-Sinai Medical Center, Los Angeles, CA., Shah JK; Division of Pediatric Critical Care Medicine, Loma Linda University Children's Hospital, Loma Linda, CA., Siegel LB; Division of Pediatric Critical Care Medicine, Cohen Children's Medical Center, New Hyde Park, NY., Tripathi S; Pediatric Intensive Care, OSF HealthCare, Children's Hospital of Illinois, Peoria, IL Peoria, IL., Wetzel RC; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA.; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA., Zhou AX; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Laura P. and Leland K. Whittier Virtual Pediatric Intensive Care Unit, Los Angeles, CA., Winter MC; Department of Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles Los Angeles, CA.; Department of Pediatrics, University of Southern California Keck School of Medicine, Los Angeles, CA.
Jazyk:	angličtina
Zdroj:	Critical care medicine [Crit Care Med] 2024 Mar 01; Vol. 52 (3), pp. 396-406. Date of Electronic Publication: 2023 Oct 27.
DOI:	10.1097/CCM.0000000000006101
Abstrakt:	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 F io2 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. Competing Interests: Dr. Pringle’s institution received funding from the National Institutes of Health (NIH) (Ul1TR001427); she received support for article research from the NIH. Dr. Winter received support for article research from the LK Whittier Foundation. The remaining authors have disclosed that they do not have any potential conflicts of interest. (Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.)
Databáze:	MEDLINE
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