Related Experiment Video
Updated: Jan 16, 2026
A Structured Approach to Extubation in Mechanically Ventilated Rats
Published on: July 18, 2025
Clinical characteristics and outcomes of patients undergoing palliative extubation
Purpose:
To characterize clinical features and outcomes of patients undergoing palliative extubation (PalExt) from mechanical ventilation (MV) and to compare these to those patients who died during MV (DMV).
Methods:
This is a single-center study including all patients undergoing MV in the Stamford Hospital ICU between 4/1/16 and 3/14/2020 and 10/1/2021 and 3/31/23, excluding those admitted during the first and second waves of Covid-19. Data were abstracted from the intensive care unit's (ICU) databases and the hospital's electronic medical record.
Results:
A total of 1911 patients underwent MV during the study period, including 226 PalExt and 177 DMV. Compared to DMV, PalExt were older, less likely to be functionally independent and more likely to be admitted with a cardiac or neurologic diagnosis. 84.5 % of PalExt were admitted to the ICU with "full code" resuscitation status and the median time to comfort care orders was 2 days. 77.0 % died in the ICU and 98.7 % died before hospital discharge. The median duration from PalExt to death in the ICU was 118 min. Patients receiving consultations from the Palliative Care service had significantly longer ICU length of stay and days of MV.
Conclusions:
This investigation documents significant differences between patients undergoing PalExt and those who die while undergoing MV.
Insights
Palliative extubation (PalExt) patients were older and had different diagnoses than those who died during mechanical ventilation (MV). Most PalExt patients died in the ICU, often within hours of extubation.
Area of Science:
- Critical Care Medicine
- Palliative Care
- Clinical Outcomes Research
Background:
- Mechanical ventilation (MV) is a critical intervention in intensive care units (ICUs).
- Understanding patient trajectories after palliative extubation (PalExt) is essential for improving end-of-life care.
- Distinguishing PalExt from in-hospital death during MV (DMV) aids in clinical decision-making.
Purpose of the Study:
- To characterize the clinical features and outcomes of patients undergoing PalExt.
- To compare these characteristics and outcomes with patients who died while on MV (DMV).
Main Methods:
- Single-center study of adult patients on MV between April 2016-March 2020 and October 2021-March 2023.
- Exclusion of patients admitted during the initial COVID-19 waves.
- Data extraction from ICU databases and electronic medical records.
Main Results:
- 226 PalExt patients and 177 DMV patients identified from 1911 MV patients.
- PalExt patients were older, less functionally independent, and more likely to have cardiac/neurologic diagnoses compared to DMV.
- 77% of PalExt patients died in the ICU, with a median time of 118 minutes from extubation to death.
Conclusions:
- Significant clinical and outcome differences exist between PalExt and DMV patient groups.
- Palliative Care consultations were associated with longer ICU stays and MV duration.
- This study highlights distinct patient profiles and care trajectories in end-of-life mechanical ventilation.
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