Abstract
Introduction: During patients' stay in the Intensive Care Unit (ICU), the attending physicians may be faced with the need to withdraw life support, such as mechanical ventilatory support. Objective: To evaluate the physicians' perception regarding palliative extubation and the factors that influence their decision making in the ICU in Colombia. Methodology: A self-applied survey was conducted among 36 physicians from different medical disciplines. Sociodemographic aspects, ethical, legal perceptions, and the influence of spirituality in the discontinuation of mechanical ventilation were analyzed. Results: The majority of participants were male ICU physicians with less than five years of intensive care experience. In terms of clinical decision-making, 92% of the participants considered that the limitation or withdrawal of therapies was a key component of medical practice in the ICU, and that it should be applied regardless of underlying medical condition. Concerning mechanical ventilation withdrawal technique, the majority (50%) chose terminal weaning, while a smaller percentage (5.6%) viewed terminal extubation as an illegal practice. This study also found that religiosity and spirituality played a relevant role in medical decision making. Conclusions: Quantitative results showed substantial variability in physician perception of palliative extubation, in particular according to specialty and religious beliefs.
1. Ortega-Chen C, Van Buren N, Kwack J, Mariano JD, Wang SE, Raman C, et al. Palliative extubation: a discussion of practices and considerations. J Pain Symptom Manage. 2023 Aug;66(2):e219-31. https://doi.org/10.1016/j.jpainsymman.2023.03.011
2. Robert R, Le Gouge A, Kentish-Barnes N, Cottereau A, Giraudeau B, Adda M, et al. Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study). Intensive Care Med. 2017 Dec;43(12):1793-807. https://doi.org/10.1007/s00134-017-4891-0
3. Ay E, Weigand MA, Röhrig R, Gruss M. Dying in the intensive care unit (ICU): a retrospective descriptive analysis of deaths in the ICU in a communal tertiary hospital in Germany. Anesthesiol Res Pract. 2020 Mar 1;2020:2356019. https://doi.org/10.1155/2020/2356019
4. Stamper TO, Kerr R, Sporter D. The evolution of palliative medicine in intensive care. Crit Care Nurs Q. 2022;45(4):332-8. https://doi.org/10.1097/CNQ.0000000000000425
5. Cottereau A, Robert R, le Gouge A, Adda M, Audibert J, Barbier F, et al. ICU physicians’ and nurses' perceptions of terminal extubation and terminal weaning: a self-questionnaire study. Intensive Care Med. 2016 Aug;42(8):1248-57. https://doi.org/10.1007/s00134-016-4373-9
6. Faber-Langendoen K. The clinical management of dying patients receiving mechanical ventilation. Chest. 1994 Sep;106(3):880-8. https://doi.org/10.1378/chest.106.3.880
7. McAree SJ, Doherty PA. A survey regarding physician preferences in end-of-life practices in intensive care across Scotland. J Intensive Care Soc. 2010 Jul;11(3):182-6. https://doi.org/10.1177/175114371001100308
8. Flannery L, Ramjan LM, Peters K. End-of-life decisions in the intensive care unit (ICU): exploring the experiences of ICU nurses and doctors. A critical literature review. Aust Crit Care. 2016 May;29(2):97-103. https://doi.org/10.1016/j.aucc.2015.07.004
9. Azoulay E, Metnitz B, Sprung CL, Timsit JF, Lemaire F, Bauer P, et al. End-of-life practices in 282 intensive care units: data from the SAPS 3 database. Intensive Care Med. 2009 Apr;35(4):623-30. https://doi.org/10.1007/s00134-008-1310-6
10. Jox RJ, Schaider A, Marckmann G, Borasio GD. Medical futility at the end of life: the perspectives of intensive care and palliative care clinicians. J Med Ethics. 2012 Sep;38(9):540-5. https://doi.org/10.1136/medethics-2011-100479
11. Sprung CL, Cohen SL, Sjokvist P, Baras M, Bulow HH, Hovilehto S, et al. End-of-life practices in European intensive care units: the Ethicus Study. JAMA. 2003 Aug 13;290(6):790-7. https://doi.org/10.1001/jama.290.6.790
12. Wenger NS, Carmel S. Physicians’ religiosity and end-of-life care attitudes and behaviors. Mt Sinai J Med. 2004 Oct;71(5):335-43. PMID: 15543435
13. Thellier D, Delannoy PY, Robineau O, Meybeck A, Boussekey N, Chiche A, et al. Comparison of terminal extubation and terminal weaning as mechanical ventilation withdrawal in ICU patients. Minerva Anestesiol. 2017 Apr;83(4):375-82. https://doi.org/10.23736/S0375-9393.16.11468-3
14. Shalman D. Clinical outcomes of a joint ICU and palliative care multidisciplinary rounding model: A retrospective cohort study. PLoS One. 2024 Feb 1;19(2):e0297288. https://doi.org/10.1371/journal.pone.0297288
15. Ma J, Chi S, Buettner B, Pollard K, Muir M, Kolekar C, et al. Early palliative care consultation in the medical ICU: a cluster randomized crossover trial. Crit Care Med. 2019 Dec;47(12):1707-15. https://doi.org/10.1097/CCM.0000000000004016
16. Helgeson SA, Burnside RC, Robinson MT, Mack RC, Ball CT, Guru PK, et al. Early versus usual palliative care consultation in the intensive care unit. Am J Hosp Palliat Care. 2023 May;40(5):544-51. https://doi.org/10.1177/10499091221115732
17. Martins BDCPCC, Oliveira RA, Cataneo AJM. Palliative care for terminally ill patients in the intensive care unit: systematic review and metaanalysis. Palliat Support Care. 2017 Jun;15(3):376-83. https://doi.org/10.1017/S1478951516000584

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