Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit*

Treece, Patsy D.; Engelberg, Ruth A.; Crowley, Lauren; Chan, Jeannie D.; Rubenfeld, Gordon D.; Steinberg, Kenneth P.; Curtis, J. Randall

doi:10.1097/01.ccm.0000125509.34805.0c

Cited by 125 publications

(78 citation statements)

References 28 publications

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“…Input from palliative care specialists and ethicists in the chronic setting would seem appropriate as well. Several commentators offer guidance for clinicians in the practical aspects of withdrawing mechanical ventilation, including the development of a standardised order form for the withdrawal of life support in the ICU [226,227].…”

Section: Home Ventilationmentioning

confidence: 99%

Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

Eur Respir J

1,656

1,499

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Weaning covers the entire process of liberating the patient from mechanical support and from the endotracheal tube. Many controversial questions remain concerning the best methods for conducting this process. An International Consensus Conference was held in April 2005 to provide recommendations regarding the management of this process. An 11-member international jury answered five pre-defined questions. 1) What is known about the epidemiology of weaning problems? 2) What is the pathophysiology of weaning failure? 3) What is the usual process of initial weaning from the ventilator? 4) Is there a role for different ventilator modes in more difficult weaning? 5) How should patients with prolonged weaning failure be managed?The main recommendations were as follows. 1) Patients should be categorised into three groups based on the difficulty and duration of the weaning process. 2) Weaning should be considered as early as possible. 3) A spontaneous breathing trial is the major diagnostic test to determine whether patients can be successfully extubated. 4) The initial trial should last 30 min and consist of either T-tube breathing or low levels of pressure support. 5) Pressure support or assist–control ventilation modes should be favoured in patients failing an initial trial/trials. 6) Noninvasive ventilation techniques should be considered in selected patients to shorten the duration of intubation but should not be routinely used as a tool for extubation failure.

show abstract

Section: Home Ventilationmentioning

confidence: 99%

Weaning from mechanical ventilation

Boles

Bion

Connors³

et al. 2007

Eur Respir J

1,656

1,499

View full text Add to dashboard Cite

show abstract

“…7 The main limitations of previous SAH scores are 2-fold: the expectation bias and limited outcomes measures. First, in the majority of patients who die in intensive care units (ICUs), care is withdrawn before death, 8 which strongly interferes with prognostic models via the so-called self-fulfilling prophecy mechanism or expectation bias. 1,[9][10][11][12] That means that physicians may make the decision to withdraw care based on certain diagnostic observations (eg, absent pupillary reflexes), which then in prognostic models turn out to be significantly associated with in-hospital mortality.…”

mentioning

confidence: 99%

Prognostication of long‐term outcomes after subarachnoid hemorrhage: The FRESH score

Witsch

Frey

Patel

et al. 2016

Annals of Neurology

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“…3375/5969 = 57% or symptom scoring. 37,38,45,50,54 Several of the interventions were comprised of multiple components. 39,54,57 Two studies were completed in France, 30,42 whereas the remainder were completed in the United States.…”

Section: Types Of Studies Interventions and Icusmentioning

confidence: 99%

Evidence-Based Palliative Care in the Intensive Care Unit: A Systematic Review of Interventions

Aslakson

Cheng

Vollenweider

et al. 2014

Journal of Palliative Medicine

238

167

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Background: Over the last 20 years, multiple interventions to better integrate palliative care and intensive care unit (ICU) care have been evaluated. This systematic review summarizes these studies and their outcomes. Methods: We searched MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CI-NAHL), the Cochrane Library, and the Web of Science; performed a search of articles published by opinion leaders in the field; and reviewed hand-search articles as of August 13, 2012. The terms ''palliative care'' and ''intensive care unit'' were mapped to MeSH subject headings and ''exploded.'' We included trials of adult patients that evaluated an ICU intervention and addressed Robert Wood Johnson group-identified domains of high-quality end-of-life care in the ICU. We excluded case series, editorials, and review articles. We compared two types of interventions, integrative and consultative, focusing on the outcomes of patient and family satisfaction, mortality, and ICU and hospital length of stay (LOS), because these were most prevalent among studies. Results: Our search strategy yielded 3328 references, of which we included 37 publications detailing 30 unique interventions. Interventions and outcome measures were heterogeneous, and many studies were underpowered and/or subject to multiple biases. Most of the interventions resulted in a decrease in hospital and ICU LOS. Few interventions significantly affected satisfaction. With one exception, the interventions decreased or had no effect on mortality. There was no evidence of harm from any intervention. Conclusions: Heterogeneity of interventions made comparison of ICU-based palliative care interventions difficult. However, existing evidence suggests proactive palliative care in the ICU, using either consultative or integrative palliative care interventions, decrease hospital and ICU LOS, do not affect satisfaction, and either decrease or do not affect mortality.

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Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit*

Cited by 125 publications

References 28 publications

Weaning from mechanical ventilation

Weaning from mechanical ventilation

Prognostication of long‐term outcomes after subarachnoid hemorrhage: The FRESH score

Evidence-Based Palliative Care in the Intensive Care Unit: A Systematic Review of Interventions

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