Extubación paliativa en cuidado crítico: una revisión narrativa

Abstract

Invasive mechanical ventilation is an artificial life support strategy to support respiratory system functions when the respiratory system is unable to cope with the metabolic demands of the body due to a specific pathology. Once medical interventions aimed at restoring the body's homeostasis have been exhausted, adequate control of the disease that led the patient to require mechanical ventilation has not been achieved, or there is no reasonable rehabilitative potential, mechanical ventilation is considered to have become futile, so the removal of the endotracheal tube becomes a strategy for the adequacy of therapeutic efforts.

This narrative review aims to study the methods used in the palliative extubation procedure, thus describing the order of steps to be followed to achieve an ideal management of the end-of-life situation in patients requiring ventilatory support. In addition, the use of some medications that are useful at the time of palliative extubation is described, as well as the legal and ethical considerations of this procedure, and the important role of the family. An exhaustive search of scientific databases was conducted to compile and analyze the relevant literature on palliative extubation in order to develop a comprehensive narrative review of the topic. A brief algorithm is proposed as a guide for decisions and behaviors in the context of palliative extubation, following four stages of the process: preparation, pre-extubation, extubation and post-extubation.