Ventilator withdrawal

Procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service

Sean O'Mahony, Marlene McHugh, Leah Zallman, Peter A. Selwyn

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

To describe an institutional procedure for ventilator withdrawal and to analyze patient responses to terminal extubation, the medical records of 21 patients who underwent withdrawal of mechanical ventilation according to the process followed by an interdisciplinary palliative care team were retrospectively reviewed. The cohort was a convenience sample of sequentially treated patients in a 1048-bed urban university-affiliated medical center. Sixteen of the 21 patients were on medical or surgical floors and five patients were in critical care units. Patients were assessed for discomfort, such as dyspnea, agitation, or anxiety. Sedative and analgesic medications were administered based on clinical parameters. Palliative care clinician observations of patient reports, tachypnea, use of accessory muscles, and signs of discomfort such as agitation or anxiety were recorded for the first 4 hours after extubation. Medication use and length of survival were recorded. Fifty-seven percent were symptomatic during the extubation process and required administration of either a benzodiazepine or opioid medication. The median survival of the 18 patients who died post-extubation was 0.83 hours (interquartile range 0.5-43.8). Bolus doses of opioid or benzodiazepine medications were effective for management of symptoms in about two-thirds of patients. One-third of patients required continuous infusions. Eighteen patients died following extubation in the medical center, and three of these patients were transferred to an inpatient hospice unit. Three patients (14%) survived to discharge from the hospital. The procedure followed provides a foundation for collaboration between palliative care and critical care services to ensure continuity of care across clinical settings/units.

Original languageEnglish (US)
Pages (from-to)954-961
Number of pages8
JournalJournal of Pain and Symptom Management
Volume26
Issue number4
DOIs
StatePublished - Oct 1 2003

Fingerprint

Mechanical Ventilators
Critical Care
Palliative Care
Benzodiazepines
Opioid Analgesics
Anxiety
Tachypnea
Hospices
Continuity of Patient Care
Survival
Hypnotics and Sedatives
Artificial Respiration
Dyspnea
Medical Records
Analgesics
Inpatients

Keywords

  • Critical care
  • Outcome
  • Palliative care
  • Symptom management procedures
  • Terminal extubation

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine
  • Clinical Neurology
  • Neurology
  • Nursing(all)

Cite this

Ventilator withdrawal : Procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service. / O'Mahony, Sean; McHugh, Marlene; Zallman, Leah; Selwyn, Peter A.

In: Journal of Pain and Symptom Management, Vol. 26, No. 4, 01.10.2003, p. 954-961.

Research output: Contribution to journalArticle

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