title: Humane terminal extubation reconsidered: the role for preemptive analgesia and sedation.
abstract: Patient comfort is not assured by common practices for terminal extubation. Treatment guidelines suggest minimizing dosage of opioids and sedatives. Multiple lines of evidence indicate that clinicians are limited in their ability to recognize distress in such patients and tend to undermedicate patients in distress. Yet suffering of any significant degree should be unacceptable. For painful procedures, such as surgery, the analogous practice of postponing anesthesia until the patient evidences discomfort would never be tolerated. Waiting for signs of suffering before initiating excellent analgesia and sedation inexorably subjects patients to distress. Therefore, when death is inevitable and imminent after extubation, suffering should be anticipated, concerns about respiratory depression dismissed, and vigorous preemptive deep sedation or anesthesia provided.
authors.affiliation: Massachusetts General Hospital, Cambridge, MA, USA. Jbillings@partners.org
authors.forename: J Andrew
authors.initials: JA
authors.lastname: Billings
mesh_terms: D060666:Airway Extubation / Q000379:methods* / Q000523:psychology; D000701:Analgesics, Opioid / Q000008:administration & dosage*; D016292:Procedural Sedation / Q000379:methods*; D004645:Empathy; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D012121:Respiration, Artificial / Q000379:methods; D013727:Terminal Care / Q000379:methods* / Q000523:psychology; D019452:Terminally Ill
chemical_list: D000701:Analgesics, Opioid