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Compassionate extubation

Andrea Postier, Kris Catrine, Stacy Remke
Little is known about the role of pediatric palliative care (PPC) programs in providing support for home compassionate extubation (HCE) when families choose to spend their child's end of life at home. Two cases are presented that highlight the ways in which the involvement of PPC teams can help to make the option available, help ensure continuity of family-centered care between hospital and home, and promote the availability of psychosocial support for the child and their entire family, health care team members, and community...
March 7, 2018: Children
Xiao Zhu, Michael M McDowell, William C Newman, Gary E Mason, Stephanie Greene, Mandeep S Tamber
Nivolumab is an immune checkpoint inhibitor (ICI) currently undergoing Phase III clinical trials for the treatment of glioblastoma. The authors present the case of a 10-year-old girl with glioblastoma treated with nivolumab under compassionate-use guidelines. After the first dose of nivolumab the patient developed hemiparesis, cerebral edema, and significant midline shift due to severe tumor necrosis. She was managed using intravenous dexamethasone and discharged on a dexamethasone taper. The patient's condition rapidly deteriorated after the second dose of nivolumab, demonstrating hemiplegia, seizures, and eventually unresponsiveness with a fixed and dilated left pupil...
February 2017: Journal of Neurosurgery. Pediatrics
Victor C Kok
BACKGROUND: The use of compassionate extubation (CE) to alleviate suffering by terminating mechanical ventilation and withdrawing the endotracheal tube requires professional adherence and efficiency. The Hospice Palliative Care Act, amended on January 9, 2013, legalizes the CE procedure in Taiwan. METHODS: From September 20, 2013 to September 2, 2014, the hospice palliative care team at a community hospital received 20 consultations for CE. Eight cases were excluded because of non-qualification...
2015: Clinical Interventions in Aging
Neelam Gupta, Emily Harrop, Susie Lapwood, Alison Shefler
BACKGROUND: Approximately two-thirds of patients who die in the pediatric intensive care unit (PICU) do so following withdrawal of intensive care treatment. Most often when intensive care treatment is withdrawn, the child remains in the PICU for end-of-life care. OBJECTIVES: This study aimed to examine the process of referral over a 6-year period of children from a PICU to children's hospices for end-of-life care. METHODS: This study carried out a retrospective review of all children referred from a large tertiary-level United Kingdom PICU to children's hospices over a 6-year period...
April 2013: Journal of Palliative Medicine
Michele C Balas, Michael Rice, Claudia Chaperon, Heather Smith, Maureen Disbot, Barry Fuchs
Delirium in older adults in critical care is associated with poor outcomes, including longer stays, higher costs, increased mortality, greater use of continuous sedation and physical restraints, increased unintended removal of catheters and self-extubation, functional decline, new institutionalization, and new onset of cognitive impairment. Diagnosing delirium is complicated because many critically ill older adults cannot communicate their needs effectively. Manifestations include reduced ability to focus attention, disorientation, memory impairment, and perceptual disturbances...
August 2012: Critical Care Nurse
Emma C Simpson, Catherine V Penrose
OBJECTIVES: At Leeds Paediatric Intensive Care Unit (PICU), whenever possible, patients are offered the opportunity to have mechanical ventilation withdrawn at a children's hospice or in the home. The aims of this study were to examine the views of the PICU staff regarding this choice, to understand their emotional and practical considerations, and to gain insight into the perceived effect on parents. DESIGN: An anonymous open-ended questionnaire and a focus group session invited comments from the multidisciplinary staff on the palliative care service, the options for the child to die outside the PICU, and the practical and emotional effects on themselves and the parents...
April 2011: International Journal of Palliative Nursing
Jennifer Susan Needle
Our objective is to present a case report of home extubation by a pediatric intensive care team in a terminally ill pediatric patient. Literature relevant to home extubation will be reviewed. The design is a case report. Home extubation of critically ill children may offer significant benefits and an alternative end-of-life option for families. Allowing a child to die at home creates an opportunity for families to maintain privacy and to better address their spiritual and cultural needs at the time of death...
May 2010: Pediatric Critical Care Medicine
Ann Walia, Roman Schumann
PURPOSE OF REVIEW: Over the last 40 years, liver transplantation developed from a compassionate attempt to save the lives of patients with end stage liver disease into a sophisticated therapy, for which 1-year survival rates now approach 90%. To understand the evolution of anesthetic perioperative care, its origin needs to be considered. The implications of this evolution on patient outcomes are important and have not been comprehensively reviewed. This article attempts to fill this gap...
June 2008: Current Opinion in Organ Transplantation
Margaret L Campbell
Eight published accounts about ventilator withdrawal spanning 1992-2004 were selected for review. Articles were selected if they contained data that described the processes comprising the withdrawal of mechanical ventilation as a terminal illness event. The purpose of this article is to synthesize the existing evidence about processes for the compassionate withdrawal of mechanical ventilation from intensive care unit patients, including measures of distress, premedication, medication during withdrawal, withdrawal methods, extubation considerations, duration of survival, and relationship of opioids or benzodiazepines to duration of survival...
October 2007: AACN Advanced Critical Care
Ted Zwerdling, Kevin C Hamann, Alexander A Kon
Compassionate home extubation for pediatric patients is a topic that seldom appears in the literature and is of unknown clinical importance. However, standards in pediatric intensive care unit (PICU) and among pediatric critical care physicians regarding end-of-life decisions are changing, including where and when patient extubation occurs. The authors' hospice recently consulted on an infant with spinal muscular atrophy in the PICU requiring mechanical ventilation, for whom further life-sustaining care was deemed futile...
June 2006: American Journal of Hospice & Palliative Care
A Tung
Indications for mechanical ventilation have evolved substantially since widespread use of ventilatory support began in the early 1960s. While the metabolic and blood-gas alterations that mandate institution of ventilatory support have remained unaltered, new noninvasive modes of ventilation have widened the therapeutic options available to patients in acute respiratory failure. An understanding of the effect of mechanical ventilation on other organ systems has clarified the role of mechanical ventilation in the treatment of conditions other than respiratory failure such as stroke or head injury...
1997: International Anesthesiology Clinics
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