The decision to extubate a patient who is ventilator-dependent is usually difficult. Problems may arise in communication with the patient and/or family, issues of differences in beliefs and culture with regard to life-sustaining treatment, certainty of prognosis, practical issues of location (in the ICU, on a med-surg floor, at home, or referral to a hospice inpatient care center) and care delivery. The following case illustrates some of these.
