title: Comparison of terminal extubation and terminal weaning as mechanical ventilation withdrawal in ICU patients.
abstract: BACKGROUND
  Terminal extubation (TE) is applied in some Intensive Care Units (ICU) patients when a decision of withdrawal of mechanical ventilation is decided. Other units prefer terminal weaning (TW) with no removal of the endotracheal tube. We report our experience with these two procedures.
  
  
  METHODS
  We conducted a retrospective study analyzing patients deceased in our ICU after a decision of life sustained therapy (LST) during the year 2013. TE was proposed to family members for patients presenting with two medical conditions: lack of vasoactive drugs (VAD) and SaO2>95% with a FIO2<50%. TW, defined by the reduction of oxygenation and/or the discontinuation of VAD, was proposed for patients receiving a FIO2≥50% and/or VAD. The two procedures were performed after obtaining a Cambridge Score-5 with sedatives.
  
  
  RESULTS
  Sixty eight patients died after withdrawal of LST. TE was performed for 22 patients and TW for 46. There was no difference in mean age, mean length of ICU stay, cause of ICU admission and dose of sedatives used during withdrawal procedure between the two groups. All family members approved the decision of TE. In this group, family members of each patient were present in ICU room at time of death, while they were present at this moment for 32 (69.5%) patients with TW.
  
  
  CONCLUSIONS
  In our Unit, TE is a practice largely approved by family members. This procedure does not require higher doses of sedatives and allows the nearest relatives to be present at time of death.
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Damien
authors.initials: D
authors.lastname: Thellier
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Pierre Y
authors.initials: PY
authors.lastname: Delannoy
authors.affiliation: Infectious Diseases Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Robineau
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Agnès
authors.initials: A
authors.lastname: Meybeck
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Boussekey
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Arnaud
authors.initials: A
authors.lastname: Chiche
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France.
authors.forename: Olivier
authors.initials: O
authors.lastname: Leroy
authors.affiliation: Intensive Care Unit, Chatiliez Hospital, Tourcoing, France - hgeorges@ch-tourcoing.fr.
authors.forename: Hugues
authors.initials: H
authors.lastname: Georges
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D060666:Airway Extubation / Q000379:methods*; D003422:Critical Care; D003643:Death; D005190:Family; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015300:Ventilator Weaning / Q000379:methods*; D028761:Withholding Treatment