Compassionate extubation in the home: It takes a team

Abstract

Objectives * Describe steps to take before starting the procedure to ensure comfort for the patient and family. * Identify likely symptoms during and after the extubation and their management. * Describe ways to support family and staff during and after the extubation. Compassionate extubation or the removal of mechanical ventilation in the home requires the involvement of the entire hospice team to ensure both patient and family comfort. With the assistance of the hospice physician, nurse, social worker and chaplain, patients and families should not have to leave their home to come off ventilatory support. We will present four cases of home discontinuation of support: two elderly female patients and two children. We did not have IV access in any of the cases but were able to anticipate and manage their symptoms using subcutaneous medications administered via a pump or medications administered via a gastric tube in one of the pediatric patients. The process involved the whole team (ie, hospice physician, nurse case manager, social worker, and spiritual counselor) making visits to the home prior to and during the extubation. Also, the pharmacy department was essential in providing assistance in symptom management. These were emotionally difficult experiences for staff, as well as for families. We will describe ways to provide effective bereavement support for families as well as support for staff. Our hospice team was able to provide what these patients and families needed in a compassionate way and in an appropriate setting. Review of the literature reveals little information on home extubation. We hope to provide information on positive experiences for patients, their families, and staff.