The Together for Short Lives Extubation Care Pathway aims to support extubation and to complement our three 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 in 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 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 Extubation Care Pathway is guided by standards at each stage of the journey, underpinned by a series of goals. We have produced a Standards Framework, with associated self-assessment audit tool relating to the standards and the goals in the Extubation Care Pathway. This will enable teams to map how their service performs and then think about areas for development where the standards may not be fully met.