Palliative withdrawal ventilation: why, when and how to do it?

Palliative extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur It may be considered when all attempts at weaning from ventilation have failed and when maintenance of ventilatory support becomes futile and is a complex procedure that demands clearly defined and meticulous planning as well as trained staff However despite the relevance of adequate planning and execution the literature provides little information on how to perform palliative extubation properly Most of published works are focused on specific aspects of the procedure like communication skills or the choice of drugs Nevertheless just a few articles provide detailed information about the whole process Considering the complex technical ethical emotional and scientific implications of palliative extubation we reviewed the available data from the literature and developed a protocol whose main aim is to define and clarify this procedure to improve the quality and safety of the care provided to this population of patients The protocol was implemented following approval by the ethics committee of our institution and the Technical Chamber for Palliative Care Regional Medical Council of the State of S atilde o Paulo Brazil