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Updated: Jan 12, 2026
Guidelines for Elective Pediatric Fiberoptic Intubation
Published on: January 17, 2011
Palliative extubation in pediatrics: a scoping review
Carolina de Araújo Affonseca1, Luís Fernando Andrade de Carvalho2, Lêni Márcia Anchieta3
1Unimed Belo Horizonte, Belo Horizonte, MG, Brazil.
Insights
Palliative extubation in children involves specific practices and experiences. Understanding these is crucial for effective clinical decisions in pediatric palliative care.
Area of Science:
- Pediatric critical care medicine
- Palliative care research
- Evidence synthesis
Background:
- Palliative extubation in pediatrics is an evolving area within palliative care.
- Limited synthesized evidence exists on current practices and patient experiences.
Purpose of the Study:
- To systematically review and synthesize existing literature on palliative extubation in pediatric patients.
- To identify knowledge gaps and future research directions in this specialized field.
Main Methods:
- Systematic literature review following PRISMA-ScR and JBI Collaboration guidelines.
- Searches across major databases (PubMed, Scopus, Web of Science, etc.) for studies on pediatric palliative extubation.
- Data extraction and quality appraisal by two independent reviewers.
Main Results:
- Twelve articles (8 case reports, 4 cross-sectional studies) involving 129 patients were included.
- Palliative extubation predominantly occurred in hospital ICUs (72.6%), utilizing endotracheal tubes (93%).
- Analgesia/sedation was common (95.3%), with most patients (90.6%) dying after withdrawal of support.
Conclusions:
- Synthesized knowledge on pediatric palliative extubation practices and experiences is vital.
- Informed decision-making requires understanding challenges to ensure timely and appropriate procedures.
- Further research is needed to optimize care delivery in pediatric palliative extubation.
Objective:
To evaluate evidence in the literature on palliative extubation in pediatrics in the context of palliative care, in any healthcare setting, to synthesize knowledge, identify gaps, and highlight future research opportunities.
Data Sources:
The PRISMA-ScR recommendations and the JBI Collaboration method were used. Searches were conducted in: Virtual Health Library, PubMed, Scopus, Embase, Cochrane Library and Web of Science. The following strategy was used: Population - children and adolescents (0 to 18 years) undergoing invasive mechanical ventilation; Concept - practices, experiences, or approaches related to palliative extubation; Context - palliative care in a hospital, hospice or home setting. Original articles published up to April 2025 were included; those that didn't define age or were over 18 years, opinion pieces, editorials, and conference proceedings were excluded. Two independent reviewers extracted the data; discrepancies were resolved by consensus or with a third reviewer. The quality of the studies was assessed using the critical appraisal tools recommended by the JBI.
Data Synthesis:
Twelve articles were selected: eight case reports and four cross-sectional studies, totaling 129 patients; 128 were analyzed. In 78.1% of cases, palliative extubation was performed in a hospital setting, mainly in the ICU (72.6%); 93% used an endotracheal tube; 95.3% received analgesia/sedation around the time of extubation; 90.6% died after support withdrawn.
Conclusions:
Knowledge of practices, experiences, and challenges related to palliative extubation in pediatrics is essential to support clinical decision-making and ensure that it is performed in a timely, responsible, and technically appropriate manner, following the principles of palliative care.
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