Time to Death After Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions

Overview

Journal J Palliat Med

Specialty Critical Care

Date 2015 Nov 12

PMID 26555010

Citations 11

Authors

Ann C Long

Sarah Muni

Patsy D Treece

Ruth A Engelberg

Elizabeth L Nielsen

Annette L Fitzpatrick

J Randall Curtis

Affiliations

Soon will be listed here.

Abstract

Background: Discussions about withdrawal of life-sustaining therapies often include family members of critically ill patients. These conversations should address essential components of the dying process, including expected time to death after withdrawal.

Objectives: The study objective was to aid physician communication about the dying process by identifying predictors of time to death after terminal withdrawal of mechanical ventilation.

Methods: We conducted an observational analysis from a single-center, before-after evaluation of an intervention to improve palliative care. We studied 330 patients who died after terminal withdrawal of mechanical ventilation. Predictors included patient demographics, laboratory, respiratory, and physiologic variables, and medication use.

Results: The median time to death for the entire cohort was 0.58 hours (interquartile range (IQR) 0.22-2.25 hours) after withdrawal of mechanical ventilation. Using Cox regression, independent predictors of shorter time to death included higher positive end-expiratory pressure (per 1 cm H2O hazard ratio [HR], 1.07; 95% CI 1.04-1.11); higher static pressure (per 1 cm H2O HR, 1.03; 95% CI 1.01-1.04); extubation prior to death (HR, 1.41; 95% CI 1.06-1.86); and presence of diabetes (HR, 1.75; 95% CI 1.25-2.44). Higher noninvasive mean arterial pressure predicted longer time to death (per 1 mmHg HR, 0.98; 95% CI 0.97-0.99).

Conclusions: Comorbid illness and key respiratory and physiologic parameters may inform physician predictions of time to death after withdrawal of mechanical ventilation. An understanding of the predictors of time to death may facilitate discussions with family members of dying patients and improve communication about end-of-life care.

Citing Articles

Effectiveness of an Algorithmic Approach to Ventilator Withdrawal at the End of Life: A Stepped Wedge Cluster Randomized Trial.

Campbell M, Yarandi H J Palliat Med. 2023; 27(2):185-191.

PMID: 37594769 PMC: 10825265. DOI: 10.1089/jpm.2023.0128.

Evidence Guiding Withdrawal of Mechanical Ventilation at the End of Life: A Review.

Mazzu M, Campbell M, Schwartzstein R, White D, Mitchell S, Fehnel C J Pain Symptom Manage. 2023; 66(3):e399-e426.

PMID: 37244527 PMC: 10527530. DOI: 10.1016/j.jpainsymman.2023.05.009.

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era.

Zheng Y, Huang Y, Chen P, Chiu H, Wu H, Chu C Eur J Med Res. 2023; 28(1):21.

PMID: 36631882 PMC: 9832251. DOI: 10.1186/s40001-022-00972-w.

End-of-Life and Palliative Care in a Critical Care Setting: The Crucial Role of the Critical Care Pharmacist.

Sloss R, Mehta R, Metaxa V Pharmacy (Basel). 2022; 10(5).

PMID: 36136840 PMC: 9498871. DOI: 10.3390/pharmacy10050107.

Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children.

Winter M, Ledbetter D Crit Care Explor. 2022; 4(9):e0764.

PMID: 36101830 PMC: 9462532. DOI: 10.1097/CCE.0000000000000764.

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