• Charlene P Pringle, Stephanie L Filipp, Wynne E Morrison, Nina A Fainberg, Melissa D Aczon, Michael Avesar, Kimberly F Burkiewicz, Harsha K Chandnani, Stephanie C Hsu, Eugene Laksana, David R Ledbetter, Michael C McCrory, Katie R Morrow, Anna E Noguchi, Caitlin E O'Brien, Apoorva Ojha, Patrick A Ross, Sareen Shah, Jui K Shah, Linda B Siegel, Sandeep Tripathi, Randall C Wetzel, Alice X Zhou, and Meredith C Winter.
• Department of Pediatrics, Critical Care Medicine, University of Florida, Gainesville, FL.
• Crit. Care Med. 2024 Mar 1; 52 (3): 396406396-406.

ObjectiveTerminal extubation (TE) and terminal weaning (TW) during withdrawal of life-sustaining therapies (WLSTs) have been described and defined in adults. The recent Death One Hour After Terminal Extubation study aimed to validate a model developed to predict whether a child would die within 1 hour after discontinuation of mechanical ventilation for WLST. Although TW has not been described in children, pre-extubation weaning has been known to occur before WLST, though to what extent is unknown. In this preplanned secondary analysis, we aim to describe/define TE and pre-extubation weaning (PW) in children and compare characteristics of patients who had ventilatory support decreased before WLST with those who did not.DesignSecondary analysis of multicenter retrospective cohort study.SettingTen PICUs in the United States between 2009 and 2021.PatientsNine hundred thirteen patients 0-21 years old who died after WLST.InterventionsNone.Measurements And Main Results71.4% ( n = 652) had TE without decrease in ventilatory support in the 6 hours prior. TE without decrease in ventilatory support in the 6 hours prior = 71.4% ( n = 652) of our sample. Clinically relevant decrease in ventilatory support before WLST = 11% ( n = 100), and 17.6% ( n = 161) had likely incidental decrease in ventilatory support before WLST. Relevant ventilator parameters decreased were F io2 and/or ventilator set rates. There were no significant differences in any of the other evaluated patient characteristics between groups (weight, body mass index, unit type, primary diagnostic category, presence of coma, time to death after WLST, analgosedative requirements, postextubation respiratory support modality).ConclusionsDecreasing ventilatory support before WLST with extubation in children does occur. This practice was not associated with significant differences in palliative analgosedation doses or time to death after extubation.Copyright © 2023 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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