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Original Article04-16-2025
Practice of pediatric palliative extubation in Brazil: a case series
Critical Care Science. 2025;37:e20250176
Abstract
Original ArticlePractice of pediatric palliative extubation in Brazil: a case series
Critical Care Science. 2025;37:e20250176
DOI 10.62675/2965-2774.20250176
Views127ABSTRACT
Objective:
To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.
Methods:
This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.
Results:
In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.
Conclusion:
Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.
Keywords:Airway extubationchildChronic diseasesInfant, newbornPalliative CarePatient dischargePediatric intensive care unitsRespiration, artificialVentilator weaningSee moreViews127
Abstract
Original ArticlePractice of pediatric palliative extubation in Brazil: a case series
Critical Care Science. 2025;37:e20250176
DOI 10.62675/2965-2774.20250176
Views127ABSTRACT
Objective:
To describe the clinical profile, procedures applied and outcomes of patients undergoing palliative extubation in the pediatric intensive care unit at a high-complexity teaching hospital in the northeastern region of Brazil.
Methods:
This is a descriptive analysis of a case series that included patients aged under 14 years who underwent palliative extubation in the pediatric intensive care unit between 2016 and 2023 (seven years). Data on admission diagnoses, palliative extubation indications, applied therapies, and outcomes following palliative extubation were retrieved from medical records.
Results:
In total, 35 patients were included in the service database. In eight patients, reports could not be found, and these patients were excluded. Twenty-seven patients aged between five days and ten years, mostly females (51.8%) and those with chronic diseases (77.8%), were included in the study. All patients were classified on the basis of World Health Organization pediatric palliative care indication categories. Palliative extubation was considered after the identification of severe neurological impairment, inadequate response or absence of curative therapies, and failure of mechanical ventilation weaning. Palliative care approaches were discussed with the family in 74% of the cases before palliative extubation. Following palliative extubation, 48.1% of patients presented symptoms, and dyspnea (84.6%) and agitation (53.8%) were the most common symptoms. Death occurred in 88.8% of the children from 20 minutes to 38 days after palliative extubation at the hospital. Three children (11.2%) were discharged from the hospital.
Conclusion:
Palliative extubation was mostly performed in infants diagnosed with complex chronic conditions and severe and irreversible diseases, all of whom were referred to other palliative care. Death in the hospital while controlling for some symptoms was the main outcome.
Keywords:Airway extubationchildChronic diseasesInfant, newbornPalliative CarePatient dischargePediatric intensive care unitsRespiration, artificialVentilator weaningSee more -
Guidelines and Consensus09-03-2024
Position statement of the Brazilian Palliative Care Academy on withdrawing and withholding life-sustaining interventions in the context of palliative care
- Edison Iglesias de Oliveira Vidal
, - Sabrina Correa da Costa Ribeiro ,
- Maria Júlia Kovacs ,
- Luciano Máximo da Silva ,
- Daniele Pompei Sacardo , [ ... ],
- Fernanda Gomes Lopes
Abstract
Guidelines and ConsensusPosition statement of the Brazilian Palliative Care Academy on withdrawing and withholding life-sustaining interventions in the context of palliative care
Critical Care Science. 2024;36:e20240021en
DOI 10.62675/2965-2774.20240021-en
- Edison Iglesias de Oliveira Vidal ,
- Sabrina Correa da Costa Ribeiro ,
- Maria Júlia Kovacs ,
- Luciano Máximo da Silva ,
- Daniele Pompei Sacardo ,
- Simone Brasil de Oliveira Iglesias ,
- Josimário João´da Silva ,
- Cinara Carneiro Neves ,
- Diego Lima Ribeiro ,
- Fernanda Gomes Lopes
Views120ABSTRACT
The issue of withrawing and withholding life-sustaining interventions is an important source of controversy among healthcare professionals caring for patients with serious illnesses. Misguided decisions, both in terms of the introduction/maintenance and the withdrawal/withholding of these measures, represent a source of avoidable suffering for patients, their loved ones, and healthcare professionals. This document represents the position statement of the Bioethics Committee of the Brazilian Palliative Care Academy on this issue and establishes seven principles to guide, from a bioethical perspective, the approach to situations related to this topic in the context of palliative care in Brazil. The position statement establishes the equivalence between the withdrawal and withholding of life-sustaining interventions and the inadequacy related to initiating or maintaining such measures in contexts where they are in disagreement with the values and care goals defined together with patients and their families. Additionally, the position statement distinguishes strictly futile treatments from potentially inappropriate treatments and elucidates their critical implications for the appropriateness of the medical decision-making process in this context. Finally, we address the issue of conscientious objection and its limits, determine that the ethical commitment to the relief of suffering should not be influenced by the decision to employ or not employ life-sustaining interventions and warn against the use of language that causes patients/families to believe that only one of the available options related to the use or nonuse of these interventions will enable the relief of suffering.
Keywords:bioethicsClinical decision-makingConsensusEthics, medicalPalliative CareWithholding TreatmentSee moreViews120Abstract
Guidelines and ConsensusPosition statement of the Brazilian Palliative Care Academy on withdrawing and withholding life-sustaining interventions in the context of palliative care
Critical Care Science. 2024;36:e20240021en
DOI 10.62675/2965-2774.20240021-en
- Edison Iglesias de Oliveira Vidal ,
- Sabrina Correa da Costa Ribeiro ,
- Maria Júlia Kovacs ,
- Luciano Máximo da Silva ,
- Daniele Pompei Sacardo ,
- Simone Brasil de Oliveira Iglesias ,
- Josimário João´da Silva ,
- Cinara Carneiro Neves ,
- Diego Lima Ribeiro ,
- Fernanda Gomes Lopes
Views120ABSTRACT
The issue of withrawing and withholding life-sustaining interventions is an important source of controversy among healthcare professionals caring for patients with serious illnesses. Misguided decisions, both in terms of the introduction/maintenance and the withdrawal/withholding of these measures, represent a source of avoidable suffering for patients, their loved ones, and healthcare professionals. This document represents the position statement of the Bioethics Committee of the Brazilian Palliative Care Academy on this issue and establishes seven principles to guide, from a bioethical perspective, the approach to situations related to this topic in the context of palliative care in Brazil. The position statement establishes the equivalence between the withdrawal and withholding of life-sustaining interventions and the inadequacy related to initiating or maintaining such measures in contexts where they are in disagreement with the values and care goals defined together with patients and their families. Additionally, the position statement distinguishes strictly futile treatments from potentially inappropriate treatments and elucidates their critical implications for the appropriateness of the medical decision-making process in this context. Finally, we address the issue of conscientious objection and its limits, determine that the ethical commitment to the relief of suffering should not be influenced by the decision to employ or not employ life-sustaining interventions and warn against the use of language that causes patients/families to believe that only one of the available options related to the use or nonuse of these interventions will enable the relief of suffering.
Keywords:bioethicsClinical decision-makingConsensusEthics, medicalPalliative CareWithholding TreatmentSee more - Edison Iglesias de Oliveira Vidal
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Original Article08-14-2024
Clinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim, [ ... ],
- Lucas Freire de Andrade
Abstract
Original ArticleClinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
Critical Care Science. 2024;36:e20240015en
DOI 10.62675/2965-2774.20240015-en
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim,
- Flaviane Ribeiro de Souza ,
- Lucas Freire de Andrade
Views104ABSTRACT
Objective:
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
Methods:
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
Results:
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Conclusion:
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
Keywords:AgedDelivery of health careFunctional statusHospitalizationintensive care unitsLength of stayPalliative CarePatient dischargeSubacute careSee moreViews104Abstract
Original ArticleClinical trajectories of critically ill patients discharged directly from a critical unit to a postacute care facility: retrospective cohort
Critical Care Science. 2024;36:e20240015en
DOI 10.62675/2965-2774.20240015-en
- João Gabriel Rosa Ramos ,
- Milton José de Souza Neto ,
- Alef Santiago Rezende,
- Flavia dos Santos Ferreira,
- Yanne Danielly Santos Amorim,
- Flaviane Ribeiro de Souza ,
- Lucas Freire de Andrade
Views104ABSTRACT
Objective:
To describe the clinical trajectories of patients discharged directly from a critical unit to a postacute care facility.
Methods:
This was a retrospective cohort study of patients who were transferred from an intensive care unit or intermediate care unit to a postacute care facility between July 2017 and April 2023. Functional status was measured by the Functional Independence Measure score.
Results:
A total of 847 patients were included in the study, and the mean age was 71 years. A total of 692 (82%) patients were admitted for rehabilitation, while 155 (18%) were admitted for palliative care. The mean length of stay in the postacute care facility was 36 days; 389 (45.9%) patients were discharged home, 173 (20.4%) were transferred to an acute hospital, and 285 (33.6%) died during hospitalization, of whom 263 (92%) had a do-not-resuscitate order. Of the patients admitted for rehabilitation purposes, 61 (9.4%) had a worsened functional status, 179 (27.6%) had no change in functional status, and 469 (63%) had an improved functional status during hospitalization. Moreover, 234 (33.8%) patients modified their care goals to palliative care, most of whom were in the group that did not improve functional status. Patients whose functional status improved during hospitalization were younger, had fewer comorbidities, had fewer previous hospitalizations, had lower rates of enteral feeding and tracheostomy, had higher Functional Independence Measure scores at admission to the postacute care facility and were more likely to be discharged home with less complex health care assistance.
Conclusion:
Postacute care facilities may play a role in the care of patients after discharge from intensive care units, both for those receiving rehabilitation and palliative care, especially for those with more severe illnesses who may not be discharged directly home.
Keywords:AgedDelivery of health careFunctional statusHospitalizationintensive care unitsLength of stayPalliative CarePatient dischargeSubacute careSee more
- João Gabriel Rosa Ramos
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Original Article06-24-2022
Reduced physical functional performance before hospitalization predicts life support limitations and mortality in nonsurgical intensive care unit patients
- Jamile Caroline Garbuglio Araujo da Silva ,
- Tiago Giraldi ,
- Carolina Matida Gontijo Coutinho ,
- Marco Antonio Carvalho Filho ,
- Dario Cecílio Fernandes , [ ... ],
- Thiago Martins Santos
Abstract
Original ArticleReduced physical functional performance before hospitalization predicts life support limitations and mortality in nonsurgical intensive care unit patients
Revista Brasileira de Terapia Intensiva. 2022;34(1):166-175
DOI 10.5935/0103-507X.20220011-en
- Jamile Caroline Garbuglio Araujo da Silva ,
- Tiago Giraldi ,
- Carolina Matida Gontijo Coutinho ,
- Marco Antonio Carvalho Filho ,
- Dario Cecílio Fernandes ,
- Thiago Martins Santos
Views46ABSTRACT
Objective:
To assess whether scales of physical functional performance and the surprise question (“Would I be surprised if this patient died in 6 months?”) predict life support limitations and mortality in critically ill nonsurgical patients.
Methods:
We included 114 patients admitted from the Emergency Department to an intensive care unit in this prospective cohort. Physical functional performance was assessed by the Palliative Prognostic Score, Karnofsky Performance Status, and the Katz Activities of Daily Living scale. Two intensivists responded to the surprise question.
Results:
The proposed physical functional performance scores were significantly lower in patients with life support limitations and those who died during the hospital stay. A negative response to the surprise question was more frequent in the same subset of patients. Adjusted univariable analysis showed an increased odds ratio for life support limitations and death regarding the activities of daily living scale (1.35 [1.01 - 1.78] and 1.34 [1.0 - 1.79], respectively) and a negative response for the surprise question (42.35 [11.62 - 154.43] and 47.79 [11.41 - 200.25], respectively); with a p < 0.05 for all results.
Conclusion:
All physical functional performance scales showed lower scores in nonsurvivors and patients with life support limitations. The activities of daily living score and the surprise question increased the odds of life support limitations and mortality in our cohort of nonsurgical intensive care unit patients admitted from the Emergency Department.
Keywords:Activities of daily livingintensive care unitsKarnofsky Performance StatusPalliative CarePhysical functional performanceSee moreViews46Abstract
Original ArticleReduced physical functional performance before hospitalization predicts life support limitations and mortality in nonsurgical intensive care unit patients
Revista Brasileira de Terapia Intensiva. 2022;34(1):166-175
DOI 10.5935/0103-507X.20220011-en
- Jamile Caroline Garbuglio Araujo da Silva ,
- Tiago Giraldi ,
- Carolina Matida Gontijo Coutinho ,
- Marco Antonio Carvalho Filho ,
- Dario Cecílio Fernandes ,
- Thiago Martins Santos
Views46ABSTRACT
Objective:
To assess whether scales of physical functional performance and the surprise question (“Would I be surprised if this patient died in 6 months?”) predict life support limitations and mortality in critically ill nonsurgical patients.
Methods:
We included 114 patients admitted from the Emergency Department to an intensive care unit in this prospective cohort. Physical functional performance was assessed by the Palliative Prognostic Score, Karnofsky Performance Status, and the Katz Activities of Daily Living scale. Two intensivists responded to the surprise question.
Results:
The proposed physical functional performance scores were significantly lower in patients with life support limitations and those who died during the hospital stay. A negative response to the surprise question was more frequent in the same subset of patients. Adjusted univariable analysis showed an increased odds ratio for life support limitations and death regarding the activities of daily living scale (1.35 [1.01 - 1.78] and 1.34 [1.0 - 1.79], respectively) and a negative response for the surprise question (42.35 [11.62 - 154.43] and 47.79 [11.41 - 200.25], respectively); with a p < 0.05 for all results.
Conclusion:
All physical functional performance scales showed lower scores in nonsurvivors and patients with life support limitations. The activities of daily living score and the surprise question increased the odds of life support limitations and mortality in our cohort of nonsurgical intensive care unit patients admitted from the Emergency Department.
Keywords:Activities of daily livingintensive care unitsKarnofsky Performance StatusPalliative CarePhysical functional performanceSee more
- Jamile Caroline Garbuglio Araujo da Silva
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Review Article04-19-2021
Neuropalliative care: new perspectives of intensive care
- Erica Regina Ribeiro Sady ,
- Lígia Maria Coscrato Junqueira Silva,
- Viviane Cordeiro Veiga ,
- Salomón Soriano Ordinola Rojas
Abstract
Review ArticleNeuropalliative care: new perspectives of intensive care
Revista Brasileira de Terapia Intensiva. 2021;33(1):146-153
DOI 10.5935/0103-507X.20210016
- Erica Regina Ribeiro Sady ,
- Lígia Maria Coscrato Junqueira Silva,
- Viviane Cordeiro Veiga ,
- Salomón Soriano Ordinola Rojas
Views90See moreABSTRACT
Neurological diseases are estimated to affect 1 billion people worldwide and are the cause of one in 10 deaths. In Brazil, they are responsible for approximately 14% of clinical admissions to intensive care units, 9% of elective neurosurgeries and 14% of emergency neurosurgeries. Many of these conditions are incurable, result in reduced life expectancy and quality of life and increased dependence, and are associated with symptoms that are likely to cause suffering, which justifies the integration of palliative care into usual care. In addition, factors unique to acute neurological injuries, such as their catastrophic clinical presentation, complex and uncertain prognosis, associated communication difficulties and issues related to quality of life, require a specific approach, which has recently been termed "neuropalliative care". Although the topic is relevant and current, it is still little discussed, and much of what is known about palliative care in this context is extrapolated from approaches used under other conditions. Therefore, the objective of this study was to conduct a narrative literature review to identify the challenges of applying the palliative care approach in the care of neurocritically ill patients, with a focus on three groups: neurocritically ill patients, families and intensive care teams. This review identified that in intensive care, the main demands for palliative care are for prognostic definitions and care planning. Training in primary palliative care and improving communication were also needs identified by intensivists and families, respectively. In contrast with what has been found under other conditions, the management of symptoms was not indicated as a complex issue, although it is still relevant.
Views90Abstract
Review ArticleNeuropalliative care: new perspectives of intensive care
Revista Brasileira de Terapia Intensiva. 2021;33(1):146-153
DOI 10.5935/0103-507X.20210016
- Erica Regina Ribeiro Sady ,
- Lígia Maria Coscrato Junqueira Silva,
- Viviane Cordeiro Veiga ,
- Salomón Soriano Ordinola Rojas
Views90See moreABSTRACT
Neurological diseases are estimated to affect 1 billion people worldwide and are the cause of one in 10 deaths. In Brazil, they are responsible for approximately 14% of clinical admissions to intensive care units, 9% of elective neurosurgeries and 14% of emergency neurosurgeries. Many of these conditions are incurable, result in reduced life expectancy and quality of life and increased dependence, and are associated with symptoms that are likely to cause suffering, which justifies the integration of palliative care into usual care. In addition, factors unique to acute neurological injuries, such as their catastrophic clinical presentation, complex and uncertain prognosis, associated communication difficulties and issues related to quality of life, require a specific approach, which has recently been termed "neuropalliative care". Although the topic is relevant and current, it is still little discussed, and much of what is known about palliative care in this context is extrapolated from approaches used under other conditions. Therefore, the objective of this study was to conduct a narrative literature review to identify the challenges of applying the palliative care approach in the care of neurocritically ill patients, with a focus on three groups: neurocritically ill patients, families and intensive care teams. This review identified that in intensive care, the main demands for palliative care are for prognostic definitions and care planning. Training in primary palliative care and improving communication were also needs identified by intensivists and families, respectively. In contrast with what has been found under other conditions, the management of symptoms was not indicated as a complex issue, although it is still relevant.
- Erica Regina Ribeiro Sady
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Original Article01-13-2020
Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit
- Fábio Holanda Lacerda ,
- Pedro Garcia Checoli,
- Carla Marchini Dias da Silva,
- Carlos Eduardo Brandão,
- Daniel Neves Forte, [ ... ],
- Bruno Adler Maccagnan Pinheiro Besen
Abstract
Original ArticleMechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit
Revista Brasileira de Terapia Intensiva. 2020;32(4):528-534
DOI 10.5935/0103-507X.20200090
- Fábio Holanda Lacerda ,
- Pedro Garcia Checoli,
- Carla Marchini Dias da Silva,
- Carlos Eduardo Brandão,
- Daniel Neves Forte,
- Bruno Adler Maccagnan Pinheiro Besen
Views78See moreAbstract
Objective:
To describe the characteristics and outcomes of patients undergoing mechanical ventilation withdrawal and to compare them to mechanically ventilated patients with limitations (withhold or withdrawal) of life-sustaining therapies but who did not undergo mechanical ventilation withdrawal.
Methods:
This was a retrospective cohort study from January 2014 to December 2018 of mechanically ventilated patients with any organ support limitation admitted to a single intensive care unit. We compared patients who underwent mechanical ventilation withdrawal and those who did not regarding intensive care unit and hospital mortality and length of stay in both an unadjusted analysis and a propensity score matched subsample. We also analyzed the time from mechanical ventilation withdrawal to death.
Results:
Out of 282 patients with life-sustaining therapy limitations, 31 (11%) underwent mechanical ventilation withdrawal. There was no baseline difference between groups. Intensive care unit and hospital mortality rates were 71% versus 57% and 93% versus 80%, respectively, among patients who underwent mechanical ventilation withdrawal and those who did not. The median intensive care unit length of stay was 7 versus 8 days (p = 0.6), and the hospital length of stay was 9 versus 15 days (p = 0.015). Hospital mortality was not significantly different (25/31; 81% versus 29/31; 93%; p = 0.26) after matching. The median time from mechanical ventilation withdrawal until death was 2 days [0 - 5], and 10/31 (32%) patients died within 24 hours after mechanical ventilation withdrawal.
Conclusion:
In this Brazilian report, mechanical ventilation withdrawal represented 11% of all patients with treatment limitations and was not associated with increased hospital mortality after propensity score matching on relevant covariates.
Views78Abstract
Original ArticleMechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit
Revista Brasileira de Terapia Intensiva. 2020;32(4):528-534
DOI 10.5935/0103-507X.20200090
- Fábio Holanda Lacerda ,
- Pedro Garcia Checoli,
- Carla Marchini Dias da Silva,
- Carlos Eduardo Brandão,
- Daniel Neves Forte,
- Bruno Adler Maccagnan Pinheiro Besen
Views78See moreAbstract
Objective:
To describe the characteristics and outcomes of patients undergoing mechanical ventilation withdrawal and to compare them to mechanically ventilated patients with limitations (withhold or withdrawal) of life-sustaining therapies but who did not undergo mechanical ventilation withdrawal.
Methods:
This was a retrospective cohort study from January 2014 to December 2018 of mechanically ventilated patients with any organ support limitation admitted to a single intensive care unit. We compared patients who underwent mechanical ventilation withdrawal and those who did not regarding intensive care unit and hospital mortality and length of stay in both an unadjusted analysis and a propensity score matched subsample. We also analyzed the time from mechanical ventilation withdrawal to death.
Results:
Out of 282 patients with life-sustaining therapy limitations, 31 (11%) underwent mechanical ventilation withdrawal. There was no baseline difference between groups. Intensive care unit and hospital mortality rates were 71% versus 57% and 93% versus 80%, respectively, among patients who underwent mechanical ventilation withdrawal and those who did not. The median intensive care unit length of stay was 7 versus 8 days (p = 0.6), and the hospital length of stay was 9 versus 15 days (p = 0.015). Hospital mortality was not significantly different (25/31; 81% versus 29/31; 93%; p = 0.26) after matching. The median time from mechanical ventilation withdrawal until death was 2 days [0 - 5], and 10/31 (32%) patients died within 24 hours after mechanical ventilation withdrawal.
Conclusion:
In this Brazilian report, mechanical ventilation withdrawal represented 11% of all patients with treatment limitations and was not associated with increased hospital mortality after propensity score matching on relevant covariates.
- Fábio Holanda Lacerda
-
Original Article09-03-2018
Effect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis
Revista Brasileira de Terapia Intensiva. 2018;30(3):308-316
Abstract
Original ArticleEffect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis
Revista Brasileira de Terapia Intensiva. 2018;30(3):308-316
DOI 10.5935/0103-507X.20180042
Views40ABSTRACT
Objective:
To assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations.
Methods:
Data were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program.
Results:
We analyzed 48,372 hospital admissions and 1,071 in-hospital deaths. Deaths were preceded by do-not-resuscitate orders in 276 (25.8%) cases and admissions to the intensive care unit occurred in 814 (76%) cases. Do-not-resuscitate orders increased from 125 (20.4%) to 151 (33%) cases in the pre-implementation and post-implementation periods, respectively (p < 0.001). Intensive care unit admissions occurred in 469 (76.5%) and 345 (75.3%) cases in the pre-implementation and post-implementation periods, respectively (p = 0.654). Interrupted time series analyses confirmed a trend of increased do-not-resuscitate order registrations, from an increase of 0.5% per month pre-implementation to an increase of 2.9% per month post-implementation (p < 0.001), and demonstrated a trend of decreased intensive care unit utilization, from an increase of 0.6% per month pre-implementation to a decrease of -0.9% per month in the post-implementation period (p = 0.001).
Conclusion:
The implementation of a palliative care program was associated with a trend of increased registration of do-not-resuscitate orders and a trend of decreased intensive care unit utilization during terminal hospitalizations.
Keywords:intensive care unitsInterrupted time series analysisPalliative CarePatient care planningResuscitation OrdersSee moreViews40Abstract
Original ArticleEffect of a palliative care program on trends in intensive care unit utilization and do-not-resuscitate orders during terminal hospitalizations. An interrupted time series analysis
Revista Brasileira de Terapia Intensiva. 2018;30(3):308-316
DOI 10.5935/0103-507X.20180042
Views40ABSTRACT
Objective:
To assess the effect of the implementation of a palliative care program on do-not-resuscitate orders and intensive care unit utilization during terminal hospitalizations.
Methods:
Data were retrospectively collected for all patients who died in a tertiary hospital in Brazil from May 2014 to September 2016. We analyzed the frequency of do-not-resuscitate orders and intensive care unit admissions among in-hospital deaths. Interrupted time series analyses were used to evaluate differences in trends of do-not-resuscitate orders and intensive care unit admissions before (17 months) and after (12 months) the implementation of a palliative care program.
Results:
We analyzed 48,372 hospital admissions and 1,071 in-hospital deaths. Deaths were preceded by do-not-resuscitate orders in 276 (25.8%) cases and admissions to the intensive care unit occurred in 814 (76%) cases. Do-not-resuscitate orders increased from 125 (20.4%) to 151 (33%) cases in the pre-implementation and post-implementation periods, respectively (p < 0.001). Intensive care unit admissions occurred in 469 (76.5%) and 345 (75.3%) cases in the pre-implementation and post-implementation periods, respectively (p = 0.654). Interrupted time series analyses confirmed a trend of increased do-not-resuscitate order registrations, from an increase of 0.5% per month pre-implementation to an increase of 2.9% per month post-implementation (p < 0.001), and demonstrated a trend of decreased intensive care unit utilization, from an increase of 0.6% per month pre-implementation to a decrease of -0.9% per month in the post-implementation period (p = 0.001).
Conclusion:
The implementation of a palliative care program was associated with a trend of increased registration of do-not-resuscitate orders and a trend of decreased intensive care unit utilization during terminal hospitalizations.
Keywords:intensive care unitsInterrupted time series analysisPalliative CarePatient care planningResuscitation OrdersSee more
-
Review Article01-01-2017
New concepts in palliative care in the intensive care unit
Revista Brasileira de Terapia Intensiva. 2017;29(2):222-230
Abstract
Review ArticleNew concepts in palliative care in the intensive care unit
Revista Brasileira de Terapia Intensiva. 2017;29(2):222-230
DOI 10.5935/0103-507X.20170031
Views230See moreABSTRACT
Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed.
Views230Abstract
Review ArticleNew concepts in palliative care in the intensive care unit
Revista Brasileira de Terapia Intensiva. 2017;29(2):222-230
DOI 10.5935/0103-507X.20170031
Views230See moreABSTRACT
Some patients admitted to an intensive care unit may face a terminal illness situation, which usually leads to death. Knowledge of palliative care is strongly recommended for the health care providers who are taking care of these patients. In many situations, the patients should be evaluated daily as the introduction of further treatments may not be beneficial to them. The discussions among health team members that are related to prognosis and the goals of care should be carefully evaluated in collaboration with the patients and their families. The adoption of protocols related to end-of-life patients in the intensive care unit is fundamental. A multidisciplinary team is important for determining whether the withdrawal or withholding of advanced care is required. In addition, patients and families should be informed that palliative care involves the best possible care for that specific situation, as well as respect for their wishes and the consideration of social and spiritual backgrounds. Thus, the aim of this review is to present palliative care as a reasonable option to support the intensive care unit team in assisting terminally ill patients. Updates regarding diet, mechanical ventilation, and dialysis in these patients will be presented. Additionally, the hospice-model philosophy as an alternative to the intensive care unit/hospital environment will be discussed.
Palliative Care Archives - Critical Care Science (CCS)
