Health Care Professionals’ Perceptions of Extubation During Withdrawal of Therapy in the Intensive Care Unit
Bibliographic record
Abstract
Background: Withdrawal of life-sustaining therapy can include the decision to extubate as part of end-of-life practices in the intensive care unit (ICU). Objectives: The purpose of this study was to explore ICU health care professionals (HCPs) perceptions regarding this procedure. Design: An online questionnaire was used to gather data on ICU HCPs' experiences and views regarding extubation. Setting/Subjects: This single-centered study was conducted in Switzerland from January 15 to March 15, 2019, and included physicians, nurses, and nurse assistants. Measurements: The survey assessed HCPs’ emotional and ethical responses to extubation, perceptions of patient suffering, and the management of death rattles (DR). Results: A total of 150 out of 227 invited (66%) ICU HCPs participated in the study. Extubation was negatively experienced by 65 (44%) professionals. Twenty-two HCPs (15%) perceived the procedure as violent, while 12 (8%) considered it to be equivalent to suffocation. Eleven respondents (7%) considered it as active euthanasia. Five nurses (21%) and 14 nurse assistants (14%) perceived DR as an indication of patient suffering. Eighty-nine HCPs (95%) wished to treat DR for family’s comfort, while 60 (64%) desired to care for it to alleviate their discomfort. The primary source of discomfort arose from the lack of know-how ( n = 122, 82%), patient comfort ( n = 114, 79%), and symbols of life's impermanence ( n = 76, 51%). Beliefs about family distress and patient suffering positively influenced the decision to treat DR. Conclusions: While extubation in the context of end-of-life practices might be ethically sound, HCPs differed in their views on the potential suffering and DR that might be induced by this practice. HCPs discomfort was associated with difficulties in assessing patient comfort, family distress, and lack of know-how.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.004 | 0.016 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.001 | 0.002 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".