The Together for Short Lives extubation care pathway, published in 2011, aims to support extubation and to complement all three previous pathways for babies, children and young people. It can be drawn on at any time during the child’s journey; once it has been recognised that continued invasive and aggressive treatment is not in their best interests.
We know that more children with life-limiting or life-threatening conditions are helped to live longer through ongoing advances in medical care, including the use of mechanical ventilation. Some of these children have a very poor prognosis. This pathway focuses on children who have reached the end of their life and are dependent on respiratory support. Many of these children will be in an intensive care environment.
Some of these children may be given the choice to die at home, in a children’s hospice or a hospital closer to home, where the withdrawal of mechanical ventilation is part of their end of life care plan. This pathway recognises that extubation actually means taking out a tube and discontinuing ventilation as well as all other critical care support. This process has traditionally taken place in intensive care environments virtually without exception. Now we are supporting and enabling this to happen outside of hospital; taking it into the family home or a children’s hospice.
This care pathway aims to support the overall process of extubation in a wide range of environments including: critical care settings, general hospitals, children’s hospices and at home. It provides a framework and tools to assist with the process and can be adapted to fit with local and regional services and practice.
The pathway sets out six standards and recognises that children and their families will make varies journeys according to their own unique needs and circumstances. It is designed to start as soon as possible and provides a template to ensure the child and their family are always at the centre of the care planning process.
A Standards framework for children's palliative care can also be downloaded here, setting out the key standards that form the back bone of all four of our care pathways, for easy reference. It also includes self-assessment audit tools relating to these standards, so you and your colleagues can map how your service currently performs and think about how to develop the areas where the standards may not be fully met.