Compassionate extubation for a peaceful death in the setting of a community hospital: a case-series study

Figures & data

Table 1 Demographic data of patients grouped by their underlying illness, days of intubation, strong opioid requirement, and selected physiologic abnormalities at the moment of compassionate extubation

	Group A	Group B	Group C
	Terminal-stage cancer	Non-cancer OHCA	Non-cancer organ failures
Men: women	3:3	2:1	3:0
Mean age (SD) (years)	66.3 (14.9)	72 (19.1)	80.3 (4.0)
Median age (years)	63.5	82	81
Length of stay (days)	28.5 (28.6)	9 (6.9)	185.7 (274)
Days of intubation at consultation, mean (SD)	6.8 (4.9)	7.3 (4.9)	179.3 (271.6)
Level of consciousness	E3M5VT, E1M1VT, E4M4VT, E4M4VT, E4M6VT, E1M2VT	E1M1VT, E1M1VT, E2M2VT	E1M1VT, E3M4VT, E3M4VT
Mean arterial pressure at extubation (mmHg)	78.1 (21.6)	81.1 (16.4)	81.2 (4.0)
Heart rate (bpm)	95.8 (25.6)	78.3 (27)	79 (25.5)
Respiratory rate (bpm)	18.7 (5.2)	10.7 (1.2)	16.7 (5.8)
Total dose of strong opioids as oral morphine in preceding 24 hours before extubation (mg)	76 (87.5)	3.3 (5.8)	43.3 (15.3)
Place where CE took place	All in an ICU	All in an ICU	ICU: 2; RCW: 1

Notes: Level of consciousness is represented using Glasgow coma scale with three parameters: best eye response (E), best verbal response (V), and best motor response (M); VT means verbal response affected by endotracheal intubation. Only one patient in group A with E4M6VT had clear consciousness.

Abbreviations: CE, compassionate extubation; ICU, intensive care unit; mmHg, millimeter of mercury; OHCA, out-of-hospital cardiac arrest; RCW, respiratory subacute care ward; SD, standard deviation.

Table 2 Patients underwent CE grouped by the underlying illness with recorded time from consultation to CE, and from CE to death and the proportion of patients requiring specialist social worker intervention

	Group A	Group B	Group C
	Terminal-stage cancer	Non-cancer OHCA	Non-cancer organ failures
Time (hours) from consultation to extubation, mean (SD)*	60 (53.7)	61.3 (52.2)	65.2 (69.2)
Time (hours) from extubation to death, median (range)	97 (0.2–245)	0.3 (0.2–0.4)	6.1 (3.6–71.8)
Person who signed consent for extubation	Spouse: 0 Child: 4 Self: 1 Sibling: 1	Spouse: 1 Child: 2 Self: 0 Sibling: 0	Spouse: 1 Child: 2 Self: 0 Sibling: 0
Proportion of cases who required specialist social worker intervention	50%	33%	67%

Notes:

* There was no statistically significant difference among three groups in terms of the time from consultation to extubation, P=0.8968 (Kruskal–Wallis test).

Abbreviations: CE, compassionate extubation; OHCA, out-of-hospital cardiac arrest; SD, standard deviation.

Table 3 Patients grouped by time from consultation to compassionate extubation for aborting endotracheal tube and intubation-emergent sufferings at the cut-off of 48 hours

	Less than 48 hours	Longer than 48 hours
Number of patients	8	4
Mean duration (SD)* (hours)	30 (10.9)	122 (44.7)
Median duration* (hours)	28.35	132.8
Age, mean (SD) (years)	75.5 (13.2)	62.8 (14.2)
Age, median (years)	82.5	60
Religion vs non-religion	6:2	4:0
Length of stay, mean (SD) (days)	77.8 (172)	33.3 (31.9)
Social worker intervention (Y:N)	3:5 (37.5%)	3:1 (75%)
Days of intubation at consultation, median	5.5	11.5
Group
A: terminal-stage cancer	4	2
B: non-cancer OHCA	2	1
C: non-cancer organ failures	2	1

Note:

* P=0.004, Mann–Whitney U-test.

Abbreviations: OHCA, out-of-hospital cardiac arrest; SD, standard deviation.