Palliative extubation in intensive care units: scoping review

Area of Science:

• Critical Care Medicine
• Palliative Care
• End-of-Life Care

Background:

• Palliative extubation is a critical component of end-of-life care in intensive care units.
• Existing knowledge on palliative extubation practices requires comprehensive mapping.

Purpose of the Study:

• To systematically map existing knowledge on palliative extubation in adult intensive care unit patients.
• To identify patterns, advances, gaps, and evidence for practice and research recommendations.

Main Methods:

• A scoping review was conducted following JBI guidelines, utilizing seven databases and four repositories.
• Searches were performed between October and December 2024, with independent study selection and structured data extraction.
• Analysis employed the PAGER framework to synthesize findings.

Main Results:

• The review included 44 studies, with a predominance of publications from 2023.
• Key findings cover practice recommendations, time to death, extubation vs. weaning comparisons, symptom management, and professional experiences.
• Aspects of decision-making and protocol use in palliative extubation were also addressed.

Conclusions:

• Palliative extubation practices are heterogeneous, with a scarcity of high-level evidence.
• There is a significant need for evidence-based protocols and multidisciplinary training.
• These interventions are essential for ensuring dignified end-of-life care and alleviating suffering.