Time to death after compassionate extubation in medical and neuroscience intensive care units

Abstract

Background

Medical ICU (MICU) and neuroscience ICU (NSICU) populations undergoing compassionate extubation (CE) may have different characteristics that affect post-procedure outcomes.

Objectives

To contrast clinical characteristics and evaluate time to death (TTD) following CE in MICU and NSICU populations.

Methods

Single-center retrospective cohort study of patients who completed CE in a MICU or NSICU in 2021. Data were obtained by manual chart abstraction. A Mann-Whitney U test was used to compare characteristics between the clinical units.

Results

Fifty patients were included in the study, 27 were in the MICU and 23 in the NSICU. Median age was 68 years. Patients in the MICU had a longer LOS before CE than those in the NSICU (10.0 vs. 3.0 days, p=0.001). Patients in the MICU experienced a shorter median TTD after CE than those in the NSICU (25 vs. 195 mins, p=0.004). MICU patients had a higher pre-hospital burden of illness (median CCI 6 vs 3, p=0.003), and a higher degree of organ failure at CE (median SOFA 12 vs 6, p<0.001), with more severe hypoxemia (PaO2/FiO2 ratio of 149 vs 360, p<0.001). Most MICU patients died of infection or cancer, compared with NSICU patients who had intracranial hemorrhage or ischemic stroke.

Conclusion

Patients in the NSICU underwent CE after shorter time in the ICU and survived longer afterwards than MICU patients. Patients in the MICU have a higher pre-hospital severity of illness and a higher level of organ failure at the time of CE compared with NSICU patients.