Palliative extubation in pediatrics: a scoping review

IF 3 4区医学 Q1 PEDIATRICS

Jornal de pediatria Pub Date : 2025-11-01 Epub Date: 2025-11-12 DOI:10.1016/j.jped.2025.101468

Carolina de Araújo Affonseca , Luís Fernando Andrade de Carvalho , Lêni Márcia Anchieta

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引用次数: 0

Abstract

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used an endotracheal tube; 95.3% received analgesia/sedation around the time of extubation; 90.6% died after support withdrawn.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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姑息拔管在儿科：范围审查。

目的：评价在任何医疗机构姑息治疗背景下儿科姑息拔管的文献证据，以综合知识，找出差距，并强调未来的研究机会。数据来源：采用PRISMA-ScR推荐和JBI协作方法。检索对象包括：Virtual Health Library， PubMed, Scopus, Embase， Cochrane Library和Web of Science。采用以下策略：人群：接受有创机械通气的儿童和青少年（0至18岁）；概念：与姑息拔管相关的实践、经验或方法；背景：医院、临终关怀或家庭环境中的姑息治疗。包括截至2025年4月发表的原创文章；那些没有定义年龄或超过18岁的文章、评论文章、社论和会议记录都被排除在外。两名独立的审稿人提取了数据；差异通过协商一致或与第三审稿人解决。使用JBI推荐的关键评估工具评估研究的质量。资料综合：选取12篇文献：8篇病例报告和4篇横断面研究，共计129例患者；分析了128例。在78.1%的病例中，姑息拔管是在医院进行的，主要是在ICU (72.6%)；93%使用气管内插管；95.3%的患者在拔管前后接受了镇痛/镇静；90.6%的人在撤销支持后死亡。结论：了解与儿科姑息拔管相关的实践、经验和挑战对于支持临床决策至关重要，并确保按照姑息治疗原则及时、负责任和技术上适当的方式进行拔管。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Jornal de pediatria 医学-小儿科

CiteScore

5.60

自引率

3.00%

发文量

审稿时长

43 days

期刊介绍： Jornal de Pediatria is a bimonthly publication of the Brazilian Society of Pediatrics (Sociedade Brasileira de Pediatria, SBP). It has been published without interruption since 1934. Jornal de Pediatria publishes original articles and review articles covering various areas in the field of pediatrics. By publishing relevant scientific contributions, Jornal de Pediatria aims at improving the standards of pediatrics and of the healthcare provided for children and adolescents in general, as well to foster debate about health.