An Observational Study on a Protocol for Withdrawal of Life-Sustaining Measures on Two Non-Academic Intensive Care Units in The Netherlands: Few Signs of Distress, No Suffering?

Epker, Jelle L.; Bakker, Jan; Lingsma, Hester F.; Kompanje, Erwin J. O.

doi:10.1016/j.jpainsymman.2015.05.017

Cited by 31 publications

(32 citation statements)

References 45 publications

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“…17,34,35 The latter indicates that patients in need of higher opioids dosages probably have better preserved neurological functions necessitating more opioids to maintain adequate end-of-life comfort care. 17,34,35 The latter indicates that patients in need of higher opioids dosages probably have better preserved neurological functions necessitating more opioids to maintain adequate end-of-life comfort care.…”

Section: Discussionmentioning

confidence: 99%

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External validation of prediction models for time to death in potential donors after circulatory death

Kotsopoulos

Böing-Messing

Jansen³

et al. 2018

American Journal of Transplantation

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Predicting time to death in controlled donation after circulatory death (cDCD) donors following withdrawal of life‐sustaining treatment (WLST) is important but poses a major challenge. The aim of this study is to determine factors predicting time to circulatory death within 60 minutes after WSLT and validate previously developed prediction models. In a single‐center retrospective study, we used the data of 92 potential cDCD donors. Multivariable regression analysis demonstrated that absent cough‐, corneal reflex, lower morphine dosage, and midazolam use were significantly associated with death within 60 minutes (area under the curve [AUC] 0.89; 95% confidenence interval [CI] 0.87‐0.91). External validation of the logistic regression models of de Groot et al (AUC 0.86; 95% CI 0.77‐0.95), Wind et al (AUC 0.62; 95% CI 0.49‐0.76), Davila et al (AUC 0.80; 95% CI 0.708‐0.901) and the Cox regression model by Suntharalingam et al (Harrell's c‐index 0.63), exhibited good discrimination and could fairly identify which patients died within 60 minutes. Previous prediction models did not incorporate the process of WLST. We believe that future studies should also include the process of WLST as an important predictor.

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Section: Discussionmentioning

confidence: 99%

“…Previous studies on WLST practices showed either no influence or delayed moment of death with use of sedatives and analgesics. 17,34,35 The latter indicates that patients in need of higher opioids dosages probably have better preserved neurological functions necessitating more opioids to maintain adequate end-of-life comfort care.…”

Section: Discussionmentioning

confidence: 99%

External validation of prediction models for time to death in potential donors after circulatory death

Kotsopoulos

Böing-Messing

Jansen³

et al. 2018

American Journal of Transplantation

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“…Therefore, the presence of family members during the PE must be evaluated as an exception, and needs preparation that involves the entire multidisciplinary team of the ICU. 19 In this study, patients submitted to PE had a fairly high average age (73.8 years). In a North American study, patients who were withdrawn from mechanical ventilation were also mostly elderly, with an average of 71 years.…”

Section: Discussionmentioning

confidence: 78%

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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“…Even more surprising is the fact that the authors do refer to the article of Kompanje et al 3 from 2008, in which a protocol for anticipation on symptoms of discomfort is discussed but not to the aforementioned article in which that very same protocol is evaluated in a two-year prospective intervention study. 2 Furthermore, in this study, pain also is labeled as a sign of distress. However, the presence of pain is already very difficult to evaluate in the normal critically ill (intubated and sedated) intensive care unit/ emergency room population, let alone in a population with severe cerebral trauma or even coma.…”

Section: Dear Editormentioning

confidence: 88%

“…In 2015, we published in this very same journal an article with the following title: An observational study on a protocol for withdrawal of life-sustaining measures in two non-academic intensive units in The Netherlands: few signs of distress, no suffering? 2 In this article, we describe both the incidence and severity of withdrawal of life-sustaining measurements-related stress symptoms like: terminal restlessness, congestion/stridor, and death rattle. Our study population comprises 241 patients, including 65 patients with a primary or a secondary (after cardiac arrest) neurological disease.…”

Section: Dear Editormentioning

confidence: 99%

Prevention Is Better Than Treatment, A Different Perspective on Distress Management After Comfort Care Extubation

Epker

Kompanje

2020

Journal of Pain and Symptom Management

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An Observational Study on a Protocol for Withdrawal of Life-Sustaining Measures on Two Non-Academic Intensive Care Units in The Netherlands: Few Signs of Distress, No Suffering?

Cited by 31 publications

References 45 publications

External validation of prediction models for time to death in potential donors after circulatory death

External validation of prediction models for time to death in potential donors after circulatory death

Palliative extubation: case analysis in an Intensive Care Unit

Prevention Is Better Than Treatment, A Different Perspective on Distress Management After Comfort Care Extubation

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