Terminal extubation [Neurosurgery Wiki]

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====== Terminal extubation ======

{{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1pmF_x0TvNeF2cl33U50mARsvvbwk_posbb_szudJ0ylg2F9aa/?limit=15&utm_campaign=pubmed-2&fc=20230112052833}}
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[[Intensivist]]s in the [[intensive care unit]] (ICU) are prone to use the term “terminal [[extubation]]” to describe the practice of withdrawing life-sustaining  [[mechanical ventilation]] (MV) when [[death]] is expected.
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Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between [[APACHE]] II scores and parameters with [[survival]] time were analyzed. Parameters with a p-value ≤ 0.2 in [[univariate]] analysis were included in [[multivariate]] models. [[Cox regression]] analysis was used for the multivariate analysis of survival time at 1 h and 1 day.

Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time.

An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of [[palliative care]] in the era of [[COVID-19]]. Trial registration They study was retrospectively registered. IRB No.: 202101929B0
((Zheng YC, Huang YM, Chen PY, Chiu HY, Wu HP, Chu CM, Chen WS, Kao YC, Lai CF, Shih NY, Lai CH. Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era. Eur J Med Res. 2023 Jan 11;28(1):21. doi: 10.1186/s40001-022-00972-w. PMID: 36631882.)).