Resumen
Objetivo: Analizar la extubación paliativa en las unidades de cuidados intensivos (UCI), considerando los fundamentos clínicos, la toma de decisiones, el manejo de síntomas, el apoyo a la familia, los desafíos asistenciales y lagunas en la investigación. Revisión bibliográfica: La literatura la describe como estrategia relacionada con escenarios de irreversibilidad clínica, caracterizada por retirada de la ventilación mecánica sin expectativa proporcional de recuperación, pero acompañada de manejo activo de síntomas, comunicación estructurada con familiares y apoyo multidisciplinario. Se observa que adultos y niños presentan diferencias en las estrategias de retirada del soporte ventilatorio y monitorización del confort, con un predominio de estudios observacionales, series de casos y estudios unicéntricos en la literatura disponible. Consideraciones finales: La extubación paliativa es una práctica clínica en crecimiento, pero carece de estudios con mayor solidez metodológica. Se observa que la producción científica disponible sigue siendo limitada y heterogénea, pero muestra temas recurrentes relacionados con la toma de decisiones compartida, control de síntomas, apoyo familiar y organización institucional, capaces de sustentar futuras investigaciones.
Referencias
AFFONSECA CA, et al. Palliative extubation: a five-year experience in a pediatric hospital. J Pediatr (Rio J), 2020; 96(5): 652-659.
BAETHGE C, et al. SANRA-a scale for the quality assessment of narrative review articles. Res Integr Peer Rev, 2019; 4: 5.
BRANDÃO CH, SOUZA AS, SILVA-JÚNIOR JR. Procedimento operacional padrão: extubação paliativa para profissionais de terapia intensiva. Recife: IMIP, 2023; 11p. Disponível em: https://higia.imip.org.br/bitstream/123456789/1096/1/Produto%20t%c3%a9cnico%20-%20Caio%20Henrique%20Pinto%20Brand%c3%a3o.pdf. Acessado em: 14 de abril de 2026.
BRASIL. Conselho Federal de Medicina. Resolução CFM nº 1.805/2006. Disponível em: https://portal.cfm.org.br/images/PDF/ortotanasia.pdf. Acessado em: 12 de abril de 2026.
CARVALHO RT, PARSONS HA. Manual de Cuidados Paliativos ANCP. 2. ed. São Paulo: s. n., 2012.
CHEN E, et al. Time to death after compassionate extubation in medical and neuroscience intensive care units. Heart Lung, 2025; 69: 185-191.
DARFELT IS, et al. Consensus statements on end-of-life care in ICU - A Scandinavian multidisciplinary Delphi study. Acta Anaesthesiol Scand, 2025; 69(4): e70015.
DONOHO K, et al. Compassionate extubation protocol to improve team communication and support in the neonatal intensive care unit. J Perinatol, 2021; 41(9): 2355-2362.
EFSTATHIOU N, et al. Intensive care clinicians' experiences of palliative withdrawal of mechanical ventilation: a qualitative study. BMJ Open, 2025; 15(8): e096527.
FEHNEL CR, et al. Withdrawal of Mechanical Ventilation in the Intensive Care Unit: A Prospective Observational Study. CHEST Crit Care, 2025; 3(4): 100204.
GARCIA X, et al. Pediatric Cardiac Critical Care Transport and Palliative Care. Pediatr Cardiol, 2021; 42(1): 208-212.
GARCÍA-SALIDO A, et al. Retirada de asistencia respiratoria en domicilio: toma de decisiones en cuidados paliativos pediátricos. An Pediatr (Barc), 2014; 80(3): 181-183.
GOMES ALZ, OTHERO MB. Cuidados paliativos. Estud Av, 2016; 30(88): 155-166.
GRANDHIGE AP, et al. Respiratory Therapists' Experiences and Attitudes Regarding Terminal Extubations and End-of-Life Care. Respir Care, 2016; 61(7): 891-896.
KESECIOGLU J, et al. European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. Intensive Care Med, 2024; 50(11): 1740-1766.
LOGANATHAN P, et al. Home Extubation in a Neonate. Pediatrics, 2018; 142(1): e20172845.
MARK NM, et al. Global variability in withholding and withdrawal of life-sustaining treatment in the intensive care unit: a systematic review. Intensive Care Med, 2015; 41(9): 1572-1585.
MOORE P, et al. Withdrawal and limitation of life-sustaining treatments in a paediatric intensive care unit and review of the literature. J Paediatr Child Health, 2008; 44(7-8): 404-408.
NOJE C, et al. Pediatric Critical Care Transport as a Conduit to Terminal Extubation at Home: A Case Series. Pediatr Crit Care Med, 2017; 18(1): e4-e8.
OMS. Palliative care. 2020. Disponível em: https://www.who.int/news-room/fact-sheets/detail/palliative-care. Acessado em: 30 de abril de 2026.
ORTEGA-CHEN C, et al. Palliative Extubation: A Discussion of Practices and Considerations. J Pain Symptom Manage, 2023; 66(2): e219-e231.
PAN CX, et al. How Long Does (S)He Have? Retrospective Analysis of Outcomes After Palliative Extubation in Elderly, Chronically Critically Ill Patients. Crit Care Med, 2016; 44(6): 1138-1144.
PRATA PR. The Epidemiologic Transition in Brazil. Cad Saúde Pública, 1992; 8(2): 168-175.
PRINGLE CP, et al. Ventilator Weaning and Terminal Extubation: Withdrawal of Life-Sustaining Therapy in Children. Secondary Analysis of the Death One Hour After Terminal Extubation Study. Crit Care Med, 2024; 52(3): 396-406.
ROBERT R, et al. Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study). Intensive Care Med, 2017; 43(12): 1793-1807.
ROCKER GM, et al. Most critically ill patients are perceived to die in comfort during withdrawal of life support: a Canadian multicentre study. Can J Anaesth, 2004; 51(6): 623-630.
SIMPSON EC, PENROSE CV. Compassionate extubation in children at hospice and home. Int J Palliat Nurs, 2011; 17(4): 164-169.
YEH A, et al. End of Life in the Neurological Intensive Care Unit: Is Extubating to Comfort Care Comfortable? J Pain Symptom Manage, 2019; 58(4): e14-e16.
