Impact of Guided Interventions on Terminal Extubation: A Pilot Project

Required reading for all learners: Implicit Bias impacts patient outcomes

More than 40% of deaths in critical care units occur after withdrawal of life-sustaining interventions. Evidence is lacking regarding the superiority of immediate extubation versus terminal weaning at the end of life. Immediate extubation is faster, but research is associated with a higher risk of patient distress due to dependence on anticipatory medications. Families and registered nurses may experience higher levels of trauma with increased patient distress. Terminal weaning offers a better opportunity to manage symptoms over time during gradual reduction of ventilator support, but this lengthier process may also increase nurse and family distress. At a 368-bed acute care hospital, nurses reported a lack of training on managing end-of-life symptoms associated with terminal extubation and the need for a standardized protocol to guide assessment and interventions. This study examines how the use of an evidence-based terminal extubation protocol affects bedside nursing practice.