Improving Compassionate Extubation Practices in the Pediatric Intensive Care Unit

Area of Science:

• Pediatric critical care medicine
• Quality improvement in healthcare
• End-of-life care protocols

Background:

• Variability in compassionate extubation (CE) practices in pediatric intensive care units (PICU) and cardiothoracic intensive care units (CTICU) led to inconsistent care.
• Lack of standardized procedures for CE impacted symptom management, documentation, and inter-provider communication.

Purpose of the Study:

• To implement and evaluate a protocol designed to standardize compassionate extubation (CE) practices.
• To improve symptom management, documentation accuracy, and communication among healthcare providers during CE events in pediatric critical care settings.

Main Methods:

• A quality improvement project involving the implementation of a CE protocol with a standardized order checklist and postextubation debriefing tool.
• Pre-intervention (January-December 2020) and post-intervention (February 2022-January 2023) chart reviews and staff surveys were conducted.
• A multidisciplinary team, including physicians, nurses, respiratory therapists, and palliative care specialists, oversaw the project.

Main Results:

• Significant improvements were observed in appropriate extubation order placement (6% to 69%) and timely advance care plan documentation (89% to 100%).
• Cessation of vasoactive infusions at extubation increased from 78% to 100%.
• Staff reported over 90% positive feedback regarding patient and provider comfort during CE, indicating high satisfaction with the protocol.

Conclusions:

• The implemented compassionate extubation (CE) protocol effectively enhanced documentation and communication in pediatric end-of-life care.
• Further research is recommended to identify and address barriers to conducting postextubation debriefings to optimize the CE process.