{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T09:25:03Z","timestamp":1762680303631,"version":"build-2065373602"},"reference-count":45,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2025,7,25]],"date-time":"2025-07-25T00:00:00Z","timestamp":1753401600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Palliative extubation is the termination of mechanical ventilation to allow for a natural death when a patient\u2019s goals no longer align with maintenance of ventilator support. Anticipating a patient\u2019s 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 1 h of palliative extubation within our adult burn unit population. This is a retrospective case\u2013control study. Adult patients who underwent palliative extubation from July 10, 2015 to June 30, 2023 were included. Demographics, comorbidities, injuries, and clinical parameters were collected. Variables with a P-value \u2264.1 in univariate analysis as well as age, sex, and TBSA burned (%) were included in the multivariate analysis to identify factors associated with death within 1\u00a0h of palliative extubation. P &amp;lt; .05 was considered significant. Forty-seven patients underwent palliative extubation; 25 (53.2%) died within 1\u00a0h. On univariate analysis, a 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\u00a0h of palliative extubation. Multivariable analysis demonstrated that relatively higher SOFA scores (OR\u2009=\u20092.851 [1.173-6.931]) and anion gaps (OR\u2009=\u20091.687 [1.014-2.806]) were associated with death within 1\u00a0h of palliative extubation. While some uncertainty will always be present when predicting time to death after palliative extubation, our study provides a guide to be used in goals of care discussions.<\/jats:p>","DOI":"10.1093\/jbcr\/iraf149","type":"journal-article","created":{"date-parts":[[2025,7,24]],"date-time":"2025-07-24T11:41:50Z","timestamp":1753357310000},"page":"1276-1282","source":"Crossref","is-referenced-by-count":0,"title":["How Long Do We Have? A Retrospective Review of Palliative Extubation in the Burn Unit"],"prefix":"10.1093","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1557-0156","authenticated-orcid":false,"given":"Hannah M","family":"Jones","sequence":"first","affiliation":[{"name":"Department of Surgery, Division of Acute Care Surgery, University of Iowa , Iowa City, IA 52242 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5931-2143","authenticated-orcid":false,"given":"Colette","family":"Galet","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Acute Care Surgery, University of Iowa , Iowa City, IA 52242 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-4495-9358","authenticated-orcid":false,"given":"Alexander","family":"Kurjatko","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Acute Care Surgery, University of Iowa , Iowa City, IA 52242 ,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2025,7,25]]},"reference":[{"key":"2025110904203434100_ref1","doi-asserted-by":"crossref","first-page":"439","DOI":"10.1016\/j.suc.2023.01.006","article-title":"Acute respiratory distress syndrome, mechanical ventilation, and inhalation injury in burn patients","volume":"103","author":"Bittner","year":"2023","journal-title":"Surg Clin North Am"},{"key":"2025110904203434100_ref2","doi-asserted-by":"crossref","first-page":"206","DOI":"10.1097\/BCR.0b013e3182331e73","article-title":"Multiple organ failure as a cause of death in patients with severe burns","volume":"33","author":"Kallinen","year":"2012","journal-title":"J Burn Care Res"},{"key":"2025110904203434100_ref3","doi-asserted-by":"crossref","first-page":"R183","DOI":"10.1186\/cc8170","article-title":"The leading causes of death after burn injury in a single pediatric burn center","volume":"13","author":"Williams","year":"2009","journal-title":"Crit Care"},{"key":"2025110904203434100_ref4","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1186\/s41038-018-0127-y","article-title":"Multi-institutional analysis of independent predictors for burn mortality in the United States","volume":"6","author":"Zavlin","year":"2018","journal-title":"Burns Trauma"},{"key":"2025110904203434100_ref5","doi-asserted-by":"crossref","DOI":"10.3390\/ijerph17207429","article-title":"Palliative and end-of-life care: more work is required","volume":"17","author":"Leung","year":"2020","journal-title":"Int J Environ Res Public Health"},{"key":"2025110904203434100_ref6","doi-asserted-by":"crossref","first-page":"e219","DOI":"10.1016\/j.jpainsymman.2023.03.011","article-title":"Palliative extubation: a discussion of practices and considerations","volume":"66","author":"Ortega-Chen","year":"2023","journal-title":"J Pain Symptom Manag"},{"key":"2025110904203434100_ref7","doi-asserted-by":"crossref","first-page":"e001663","DOI":"10.1136\/tsaco-2024-001663","article-title":"SAFE-GOALS: a protocol for goals of care discussions in the intensive care unit","volume":"10","author":"Velez","year":"2025","journal-title":"Trauma Surg Acute Care Open"},{"key":"2025110904203434100_ref8","doi-asserted-by":"crossref","first-page":"1341","DOI":"10.1183\/09031936.00160014","article-title":"Complicated grief after death of a relative in the intensive care unit","volume":"45","author":"Kentish-Barnes","year":"2015","journal-title":"Eur Respir J"},{"key":"2025110904203434100_ref9","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1378\/chest.09-1291","article-title":"Predictors of symptoms of posttraumatic stress and depression in family members after patient death in the ICU","volume":"137","author":"Gries","year":"2010","journal-title":"Chest"},{"key":"2025110904203434100_ref10","doi-asserted-by":"crossref","first-page":"1438","DOI":"10.1007\/s00134-024-07565-7","article-title":"Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts. An umbrella review","volume":"50","author":"Salins","year":"2024","journal-title":"Intensive Care Med"},{"key":"2025110904203434100_ref11","doi-asserted-by":"crossref","first-page":"840","DOI":"10.1097\/TA.0000000000000124","article-title":"External validation of the revised Baux score for the prediction of mortality in patients with acute burn injury","volume":"76","author":"Dokter","year":"2014","journal-title":"J Trauma Acute Care Surg"},{"key":"2025110904203434100_ref12","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1056\/NEJMp078066","article-title":"Organ donation after cardiac death","volume":"357","author":"Steinbrook","year":"2007","journal-title":"N Engl J Med"},{"key":"2025110904203434100_ref13","doi-asserted-by":"crossref","first-page":"1112","DOI":"10.1097\/TP.0000000000000186","article-title":"Prediction of death in less than 60 minutes after withdrawal of cardiorespiratory support in potential organ donors after circulatory death","volume":"98","author":"Brieva","year":"2014","journal-title":"Transplantation"},{"key":"2025110904203434100_ref14","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1097\/MOT.0b013e32835ed81b","article-title":"Time to death after withdrawal of treatment in donation after circulatory death (DCD) donors","volume":"18","author":"Bradley","year":"2013","journal-title":"Curr Opin Organ Transplant"},{"key":"2025110904203434100_ref15","doi-asserted-by":"crossref","first-page":"766","DOI":"10.1097\/CCM.0b013e318232e2e7","article-title":"Prediction of time of death after withdrawal of life-sustaining treatment in potential donors after cardiac death*","volume":"40","author":"Wind","year":"2012","journal-title":"Crit Care Med"},{"key":"2025110904203434100_ref16","doi-asserted-by":"crossref","first-page":"805","DOI":"10.1097\/EDE.0b013e3181577511","article-title":"Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration","volume":"18","author":"Vandenbroucke","year":"2007","journal-title":"Epidemiology"},{"key":"2025110904203434100_ref17","doi-asserted-by":"crossref","first-page":"800","DOI":"10.1097\/EDE.0b013e3181577654","article-title":"The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies","volume":"18","author":"von Elm","year":"2007","journal-title":"Epidemiology"},{"key":"2025110904203434100_ref18","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1097\/CCM.0b013e31822f0633","article-title":"External validation of a prognostic model predicting time of death after withdrawal of life support in neurocritical patients","volume":"40","author":"de Groot","year":"2012","journal-title":"Crit Care Med"},{"key":"2025110904203434100_ref19","doi-asserted-by":"crossref","first-page":"798","DOI":"10.1016\/j.jfma.2017.09.014","article-title":"Clinical characteristics and survival outcomes of terminally ill patients undergoing withdrawal of mechanical ventilation","volume":"117","author":"Hung","year":"2018","journal-title":"J Formos Med Assoc"},{"key":"2025110904203434100_ref20","doi-asserted-by":"crossref","first-page":"1368","DOI":"10.1089\/jpm.2013.0142","article-title":"Factors associated with palliative withdrawal of mechanical ventilation and time to death after withdrawal","volume":"16","author":"Huynh","year":"2013","journal-title":"J Palliat Med"},{"key":"2025110904203434100_ref21","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1089\/jpm.2015.0115","article-title":"Time to death after terminal withdrawal of mechanical ventilation: specific respiratory and physiologic parameters may inform physician predictions","volume":"18","author":"Long","year":"2015","journal-title":"J Palliat Med"},{"key":"2025110904203434100_ref22","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1212\/WNL.52.8.1602","article-title":"Withdrawal of life support in the neurological intensive care unit","volume":"52","author":"Mayer","year":"1999","journal-title":"Neurology"},{"key":"2025110904203434100_ref23","doi-asserted-by":"crossref","first-page":"1138","DOI":"10.1097\/CCM.0000000000001642","article-title":"How long does (s)he have? Retrospective analysis of outcomes after palliative extubation in elderly, chronically critically ill patients","volume":"44","author":"Pan","year":"2016","journal-title":"Crit Care Med"},{"key":"2025110904203434100_ref24","doi-asserted-by":"crossref","first-page":"161","DOI":"10.1097\/PCC.0000000000002612","article-title":"Machine learning to predict cardiac death within 1 hour after terminal extubation","volume":"22","author":"Winter","year":"2021","journal-title":"Pediatr Crit Care Med"},{"key":"2025110904203434100_ref25","doi-asserted-by":"crossref","first-page":"642","DOI":"10.1016\/0923-2494(92)80049-Q","article-title":"The role of perivascular and microglial cells in fibrillogenesis of beta-amyloid and PrP protein in Alzheimer\u2019s disease and scrapie","volume":"143","author":"Wisniewski","year":"1992","journal-title":"Res Immunol"},{"key":"2025110904203434100_ref26","doi-asserted-by":"crossref","first-page":"1380","DOI":"10.1212\/WNL.0b013e3181dad5f0","article-title":"Factors influencing time to death after withdrawal of life support in neurocritical patients","volume":"74","author":"Yee","year":"2010","journal-title":"Neurology"},{"key":"2025110904203434100_ref27","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40001-022-00972-w","article-title":"Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era","volume":"28","author":"Zheng","year":"2023","journal-title":"Eur J Med Res"},{"key":"2025110904203434100_ref28","doi-asserted-by":"crossref","first-page":"102","DOI":"10.2215\/CJN.04500422","article-title":"Acid-base disorders in the critically ill patient","volume":"18","author":"Achanti","year":"2023","journal-title":"Clin J Am Soc Nephrol"},{"key":"2025110904203434100_ref29","doi-asserted-by":"crossref","first-page":"13565","DOI":"10.1038\/s41598-025-95079-7","article-title":"Deep learning unlocks the true potential of organ donation after circulatory death with accurate prediction of time-to-death","volume":"15","author":"Sun","year":"2025","journal-title":"Sci Rep"},{"key":"2025110904203434100_ref30","doi-asserted-by":"crossref","first-page":"2677","DOI":"10.1097\/CCM.0b013e3182987f38","article-title":"Prediction of death in less than 60 minutes following withdrawal of cardiorespiratory support in ICUs","volume":"41","author":"Brieva","year":"2013","journal-title":"Crit Care Med"},{"key":"2025110904203434100_ref31","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1007\/s10157-019-01844-0","article-title":"Anion gap predicts early mortality after starting hemodialysis in the elderly","volume":"24","author":"Arai","year":"2020","journal-title":"Clin Exp Nephrol"},{"key":"2025110904203434100_ref32","doi-asserted-by":"crossref","first-page":"7405","DOI":"10.1038\/s41598-022-11081-3","article-title":"The association between anion gap and in-hospital mortality of post-cardiac arrest patients: a retrospective study","volume":"12","author":"Chen","year":"2022","journal-title":"Sci Rep"},{"key":"2025110904203434100_ref33","doi-asserted-by":"crossref","first-page":"579","DOI":"10.2147\/COPD.S433619","article-title":"Association between serum anion gap and mortality in critically ill patients with COPD in ICU: data from the MIMIC IV database","volume":"19","author":"Chen","year":"2024","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2025110904203434100_ref34","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1186\/s12872-021-02263-4","article-title":"Association between anion gap and mortality of aortic aneurysm in intensive care unit after open surgery","volume":"21","author":"Gao","year":"2021","journal-title":"BMC Cardiovasc Disord"},{"key":"2025110904203434100_ref35","doi-asserted-by":"crossref","first-page":"e24818","DOI":"10.1002\/jcla.24818","article-title":"The association between serum anion gap and all-cause mortality of unselected adult patients: a retrospective cohort study of &gt;20,000 patients","volume":"37","author":"Ji","year":"2023","journal-title":"J Clin Lab Anal"},{"key":"2025110904203434100_ref36","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1186\/s12893-023-02137-w","article-title":"Association between anion gap and all-cause mortality of critically ill surgical patients: a retrospective cohort study","volume":"23","author":"Sun","year":"2023","journal-title":"BMC Surg"},{"key":"2025110904203434100_ref37","doi-asserted-by":"crossref","first-page":"16670","DOI":"10.1038\/s41598-023-43928-8","article-title":"Serum anion gap is associated with mortality in intensive care unit patients with diastolic heart failure","volume":"13","author":"Xu","year":"2023","journal-title":"Sci Rep"},{"key":"2025110904203434100_ref38","doi-asserted-by":"crossref","first-page":"1591507","DOI":"10.1155\/2022\/1591507","article-title":"The anion gap and mortality in critically ill patients with hip fractures","volume":"2022","author":"Zhang","year":"2022","journal-title":"Contrast Media Mol Imaging"},{"key":"2025110904203434100_ref39","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1177\/08850666221123483","article-title":"Serum anion gap level predicts all-cause mortality in septic patients: a retrospective study based on the MIMIC III database","volume":"38","author":"Zhu","year":"2023","journal-title":"J Intensive Care Med"},{"key":"2025110904203434100_ref40","first-page":"e36653","article-title":"Mean SOFA score in comparison with APACHE II score in predicting mortality in surgical patients with sepsis","volume":"15","author":"Thakur","year":"2023","journal-title":"Cureus"},{"key":"2025110904203434100_ref41","doi-asserted-by":"crossref","first-page":"347","DOI":"10.1016\/j.burns.2019.03.006","article-title":"Predictive value of quick SOFA and revised Baux scores in burn patients","volume":"46","author":"Prasad","year":"2020","journal-title":"Burns"},{"key":"2025110904203434100_ref42","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1186\/s13054-022-04290-9","article-title":"The sequential organ failure assessment (SOFA) score: has the time come for an update?","volume":"27","author":"Moreno","year":"2023","journal-title":"Crit Care"},{"key":"2025110904203434100_ref43","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1016\/j.burns.2022.09.004","article-title":"Variation of the SOFA score and mortality in patients with severe burns: a cohort study","volume":"49","author":"Calles","year":"2023","journal-title":"Burns"},{"key":"2025110904203434100_ref44","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.hrtlng.2024.10.005","article-title":"Time to death after compassionate extubation in medical and neuroscience intensive care units","volume":"69","author":"Chen","year":"2025","journal-title":"Heart Lung"},{"key":"2025110904203434100_ref45","doi-asserted-by":"crossref","first-page":"1754","DOI":"10.1001\/jama.286.14.1754","article-title":"Serial evaluation of the SOFA score to predict outcome in critically ill patients","volume":"286","author":"Ferreira","year":"2001","journal-title":"JAMA"}],"container-title":["Journal of Burn Care &amp; Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jbcr\/advance-article-pdf\/doi\/10.1093\/jbcr\/iraf149\/63845082\/iraf149.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/46\/6\/1276\/63845082\/iraf149.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbcr\/article-pdf\/46\/6\/1276\/63845082\/iraf149.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,9]],"date-time":"2025-11-09T09:20:40Z","timestamp":1762680040000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbcr\/article\/46\/6\/1276\/8212266"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,25]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2025,7,25]]},"published-print":{"date-parts":[[2025,11,5]]}},"URL":"https:\/\/doi.org\/10.1093\/jbcr\/iraf149","relation":{},"ISSN":["1559-047X","1559-0488"],"issn-type":[{"type":"print","value":"1559-047X"},{"type":"electronic","value":"1559-0488"}],"subject":[],"published-other":{"date-parts":[[2025,11]]},"published":{"date-parts":[[2025,7,25]]}}}