How Long Do We Have?: A Retrospective Review of Palliative Extubation in the Burn Unit

Palliative extubation is the termination of mechanical ventilation to allow for a natural death when a patient’s goals no longer align with maintenance of ventilator support. Anticipating a patient’s survival time after palliative extubation is important when counseling patient families and can facilitate individualized palliative care and organ donation processes. This has not been explored in burns. Herein, we aimed at identifying factors associated with death within one hour of palliative extubation within our adult burn unit population. This is a retrospective case-control study. Adult patients who underwent palliative extubation from 7/10/2015 to 6/30/2023 were included. Demographics, comorbidities, injuries, and clinical parameters were collected. Variables with a p-value≤0.1 in univariate analysis as well as age, sex, and total body surface area burned (TBSA) (%) were included in the multivariate analysis to identify factors associated with death within 1 hour of palliative extubation. P<0.05 was considered significant. Forty-seven patients underwent palliative extubation; 25 (53.2%) died within 1 hour. On univariate analysis, higher number of vasoactive medications, Sequential Organ Failure Assessment (SOFA) scores, anion gap, phosphorus, lactic acid levels, lower mean arterial pressure, acidosis, and the absence of a history of cerebrovascular disease were associated with death less than 1 hour of palliative extubation. Multivariable analysis demonstrated that relatively higher SOFA scores (OR=2.851 [1.173-6.931]) and anion gaps (OR=1.687 [1.014-2.806]) were associated with death within 1 hour of palliative extubation. While some uncertainty will always be present when predicting time to death (TTD) after palliative extubation, our study provides a guide to be used in goals of care discussions.