A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing

Campbell, Margaret; Yarandi, Hossein; Mendez, Michael

doi:10.1089/jpm.2015.0111

Cited by 29 publications

(12 citation statements)

References 20 publications

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“…Therefore, for EP to be indicated, the application of a specific algorithm is an important tool and may help the medical team in the face of the inherent conflicts in the procedure, especially regarding the control of post-extubation respiratory discomfort. 20 It is important to remember that EP is a medical procedure and, as such, should be decided after individual evaluation of the real benefit that this procedure would bring to the patient, and the social context that involves the whole process cannot be underestimated. In addition to the need for adequate communication with the patient's family members, that there is an ethical definition and legal support regarding the withdrawal of therapies considered futile or useless.…”

Section: Discussionmentioning

confidence: 99%

Palliative extubation: case analysis in an Intensive Care Unit

Rebelatto¹,

Moritz²

2017

Mundo da Saúde

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Current technological advancements have allowed for the prolongation of the dying process, especially in Intensive Care Units (ICU). This has increased the need for decisions on the limitation of therapeutic effort (LTE), such as the use of palliative extubation that, although difficult from an emotional standpoint, has legal and ethical justifications, and has increased family acceptance. The objective was to evaluate the clinical and demographical profile of patients submitted to palliative extubation (PT) in the ICU of the University Hospital of the Universidade Federal de Santa Catarina (HU/ UFSC), Brazil. This was a historical cohort whose data were obtained from forms filled out by critical care doctors from the Hospital Death Commission at the HU/UFSC. Patients submitted to LTE that died between January 2011 and December 2014 were included in the study. The use of PT and clinical and epidemiological data were collected. LTE was indicated in 374 (53.8%) patients, with 23 (6.1%) receiving PT. Average age of patients undergoing PT was 73.8 years; 10 patients were over 60, and 9 were over 80 years of age. Ten (43.4%) patients had been previously in the ICU. The average time from checking in at the ICU and extubation was 4.4 days, and between extubation and death it was 2.5 days. Neurological disease was the main cause of death of patients subjected to PT. All family members were aware of the extubation. Family members from 2 families witnessed the extubation. Morphine was the most common analgesic prescribed. It is concluded that patients submitted to PT were older, with neurological diseases, and the average time from extubation to death was 2.5 days ResumoO desenvolvimento tecnológico do mundo atual tem permitido o prolongamento do morrer, principalmente em unidades de terapia intensiva (UTI). Torna-se crescente a necessidade de decisões de limite de esforço terapêutico (LET), do qual se destaca a extubação paliativa (EP), que embora difícil de ser aceita do ponto de vista emocional, tem respaldo ético-legal e aumenta a satisfação familiar. O estudo teve como objetivo avaliar o perfil clínico-demográfico dos pacientes extubados paliativamente (ExPl) na UTI do HU/UFSC. Trata-se de coorte histórico, cujos dados foram coletados através das fichas preenchidas por médicos intensivistas que constituem a Comissão de Óbito da instituição. Foram incluídos os pacientes que morreram na UTI/HU/UFSC, após indicação de LET, entre janeiro/2011 e dezembro/2014. Foram selecionados os pacientes que foram ExPl, sendo anotados seus dados clínicos e epidemiológicos. LET foi apontado em 374 (53,8%) pacientes, sendo 23 (6,1%) ExPl. A média da idade dos ExPl foi de 73,8 anos, 10 tinham mais de 60 e 9 mais de 80 anos. Dez (43,4%) pacientes já haviam sido internados previamente em UTI. O tempo médio entre a internação-extubação foi 4,4 dias e entre extubação-morte foi de 2,5 dias. Doença neurológica foi a principal causa da morte dos pacientes ExPl. Todos os familiares estavam cientes da EP. Familiares de 2 pacientes acompa...

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Section: Discussionmentioning

confidence: 99%

Palliative extubation: case analysis in an Intensive Care Unit

Rebelatto¹,

Moritz²

2017

Mundo da Saúde

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“…These methods were directly compared in my pilot study in which patients with rapid weaning guided by the RDOS displayed significantly more respiratory comfort than did the control group who underwent 1-step withdrawal and extubation. 16 More distress from immediate extubation compared with weaning was reported in a multisite observation study in French ICUs. 30 That study was limited by using the Behavior Pain Scale to measure patients' respiratory distress instead of a more sensitive measure, such as the RDOS.…”

Section: Withdrawal Processmentioning

confidence: 96%

“…[12][13][14][15] The RDOS has application for clinical assessment of the patient in the intensive care unit (ICU) who is undergoing treatment of respiratory distress, mechanical ventilation, spontaneous weaning trials, and, in particular, terminal ventilator withdrawal to allow a natural death. 16 Use of this objective, valid, reliable instrument takes the guesswork out of assessment of patients.…”

Section: Assessmentmentioning

confidence: 99%

Ensuring Breathing Comfort at the End of Life: The Integral Role of the Critical Care Nurse

Campbell

2018

American Journal of Critical Care

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This article describes the author’s program of clinical research focused on assessment and treatment of respiratory distress among critically ill patients at the end of life. Dyspnea is a subjective experience of breathing discomfort that occurs in the presence of cardiopulmonary and neuromuscular diseases. Dyspnea is one of the most common and most distressing symptoms experienced by critically ill patients. Many critically ill patients, particularly those not expected to survive, become cognitively impaired or unconscious and lose the ability to report symptoms, although dyspnea can be known only from a patient’s report. When self-reporting ability is lost, the critical care nurse must rely on signs indicative of a patient’s respiratory distress. The critically ill patient unable to self-report is vulnerable to under-recognition of symptom distress and subsequent over-treatment or undertreatment. When the patient is dying, there is only 1 chance to optimize the assessment and treatment of symptoms.

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“…The literature on the administration of medication before palliative extubation is scarce, and there are insufficient empirical data to support a precise indication of drugs and corresponding doses. 5 As a rule, most institutions administer opioids and/or benzodiazepines as a function of the patient's needs based on subjective criteria and the staff's experience. In our institution, we routinely administer medication before extubation to avoid respiratory distress and/or pain as much as possible.…”

Section: Premedicationmentioning

confidence: 99%

“…However, despite the relevance of adequate planning and execution, the literature provides little information on how to perform palliative extubation properly. [3][4][5] Even the main published guidelines include scarce statistical data and are primarily based on the clinical experience at institutions and address ethical and legal aspects, which certainly do not result from conventional scientific evidence. 6 Considering the complex technical, ethical, emotional and scientific implications of palliative extubation, we reviewed the available data from the literature and developed a protocol whose main aim is to define and clarify this procedure to improve the quality and safety of the care provided to this population of patients.…”

Section: Introductionmentioning

confidence: 99%

Palliative withdrawal ventilation: why, when and how to do it?

Coradazzi

Inhaia

Santana

et al. 2019

HPMIJ

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Palliative extubation consists of the withdrawal of mechanical ventilation when the absolute priority in care delivery is to afford comfort and allow for natural death to occur. It may be considered when all attempts at weaning from ventilation have failed and when maintenance of ventilatory support becomes futile and is a complex procedure that demands clearly defined and meticulous planning, as well as trained staff. However, despite the relevance of adequate planning and execution, the literature provides little information on how to perform palliative extubation properly. Most of published works are focused on specific aspects of the procedure, like communication skills, or the choice of drugs. Nevertheless, just a few articles provide detailed information about the whole process.Considering the complex technical, ethical, emotional and scientific implications of palliative extubation, we reviewed the available data from the literature and developed a protocol whose main aim is to define and clarify this procedure to improve the quality and safety of the care provided to this population of patients. The protocol was implemented following approval by the ethics committee of our institution and the Technical Chamber for Palliative Care, Regional Medical Council of the State of São Paulo, Brazil.

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A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing

Abstract: Feasibility and proof of concept for the nurse-led algorithm were established.

Cited by 29 publications

References 20 publications

Palliative extubation: case analysis in an Intensive Care Unit

Palliative extubation: case analysis in an Intensive Care Unit

Ensuring Breathing Comfort at the End of Life: The Integral Role of the Critical Care Nurse

Palliative withdrawal ventilation: why, when and how to do it?

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