Vol 17, No 4 (2023)
Case report
Published online: 2023-08-18

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Home extubation in a terminally ill older patient visiting emergency department

Pasitpon Vatcharavongvan12
Palliat Med Pract 2023;17(4):254-257.

Abstract

This case report highlights the possibility of discharging terminally ill and intubated patients from the emergency department (ED) for home extubation. Many barriers exist in the ED that hinder home extubation for elderly palliative patients. Patients intubated in the ED are typically admitted to an intensive care unit or hospice. However, the presented case is of a 93-year-old female patient brought to the ED due to altered consciousness, who experienced a sudden cardiac arrest, and subsequently received resuscitation and intubation. The patient’s family expressed their desire to have her discharged for end-of-life care at home. By establishing effective communication and cooperation between a palliative care team, the ED staff, and the family members, a discharge care plan was developed to facilitate home extubation. The patient passed away peacefully within 40 hours of extubation, surrounded by her loved ones. This case exemplifies the feasibility of discharging terminally ill and intubated patients discharging from the ED for home extubation.

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References

  1. Cooper E, Hutchinson A, Sheikh Z, et al. Palliative care in the emergency department: a systematic literature qualitative review and thematic synthesis. Palliat Med. 2018; 32(9): 1443–1454.
  2. George N, Bowman J, Aaronson E, et al. Past, present, and future of palliative care in emergency medicine in the USA. Acute Med Surg. 2020; 7(1): e497.
  3. McCallum KJ, Jackson D, Walthall H, et al. Exploring the quality of the dying and death experience in the emergency department: an integrative literature review. Int J Nurs Stud. 2018; 85: 106–117.
  4. Alqahtani AJ, Mitchell G. End-of-Life care challenges from staff viewpoints in emergency departments: systematic review. Healthcare (Basel). 2019; 7(3): 83.
  5. Di Leo S, Alquati S, Autelitano C, et al. Palliative care in the emergency department as seen by providers and users: a qualitative study. Scand J Trauma Resusc Emerg Med. 2019; 27(1): 88.
  6. Clemency BM, Grimm KT, Lauer SL, et al. Transport home and terminal extubation by emergency medical services: an example of innovation in end-of-life care. J Pain Symptom Manage. 2019; 58(2): 355–359.
  7. Lage JSS, Pincelli AdSM, Furlan JAS, et al. Palliative extubation in emergency units: a case report. Rev Bioét. 2019; 27(2): 313–317.
  8. Smith AK, McCarthy E, Weber E, et al. Half of older Americans seen in emergency department in last month of life; most admitted to hospital, and many die there. Health Aff (Millwood). 2012; 31(6): 1277–1285.
  9. Yang C, Yang TT, Tsou YJ, et al. Initiating palliative care consultation for acute critically ill patients in the emergency department intensive care unit. J Chin Med Assoc. 2020; 83(5): 500–506.
  10. Lee SY, Ro YS, Shin SDo, et al. Epidemiology of patients who died in the emergency departments and need of end-of-life care in Korea from 2016 to 2019. Sci Rep. 2023; 13(1): 686.
  11. Köstenberger M, Neuwersch S, Weixler D, et al. Prevalence of palliative care patients in emergency departments. Wien Klin Wochenschr. 2019; 131(17-18): 404–409.
  12. Delgado-Guay MO, Kim YuJ, Shin SH, et al. Avoidable and unavoidable visits to the emergency department among patients with advanced cancer receiving outpatient palliative care. J Pain Symptom Manage. 2015; 49(3): 497–504.
  13. National Health Act. Sect. 12 (2007). 2007.



Palliative Medicine in Practice