Home extubation by a pediatric critical care team: Providing a compassionate death outside the pediatric intensive care unit

Our objective is to present a case report of home extubation by a pediatric intensive care team in a terminally ill pediatric patient. Literature relevant to home extubation will be reviewed. The design is a case report. Home extubation of critically ill children may offer significant benefits and an alternative end-of-life option for families. Allowing a child to die at home creates an opportunity for families to maintain privacy and to better address their spiritual and cultural needs at the time of death. Before offering home extubation to families, hospitals should prepare families for the experience and address the availability of staff to comfort parents and provide bereavement support. Medicolegal as well as cost issues for the hospital related to home extubation should be explored before the implementation of a program of this nature. This case illustrates that home extubation is a creative, compassionate, and culturally sensitive alternative to hospital-based end-of-life care involving the pediatric intensivist, transport teams, and primary care physicians. (Pediatr Crit Care Med 2010; 11:401-403)