Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Fehnel, Corey R.; Hoz, Miguel Ángel Armengol de la; Celi, Leo Anthony; Campbell, Margaret; Hanafy, Khalid A.; Nozari, Ala; White, Douglas B.; Mitchell, Susan L.

doi:10.1016/j.chest.2020.04.027

Cited by 12 publications

(9 citation statements)

References 71 publications

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“…Mounting evidence suggests palliative benefit in the administration of anticipatory doses of opioids prior to WLST to avoid respiratory distress, 35 and avoidance of sedative monotherapy given concerns around paradoxically worsening dyspnea There were no publications recommending premedication prior to palliative ventilatory withdrawal (anticipatory dosing) among DCD patients. However premedication with analgesic medications for dyspnea was mentioned in several case reports.…”

Section: Sedative and Analgesic Regimensmentioning

confidence: 99%

End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review

Cappucci

Smith

Schwartzstein

et al. 2022

The Neurohospitalist

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Background Donation after circulatory death (DCD) is becoming increasingly common, yet little is known about the way potential donors receive end-of-life care. Purpose The aims of this systematic review are to describe the current practice in end-of-life care for potential donors and identify metrics that are being used to assess discomfort among these patients. Research design and Study Sample This review encompasses published literature between June 1, 2000 and June 31, 2020 of end-of-life care received by potential DCD patients. The population of interest was defined as patients eligible for Maastracht classification III donation after circulatory death for a solid organ transplantation. Outcomes examined included: analgesic or palliative protocols, and surrogates of discomfort (eg dyspnea, agitation). Results Among 141 unique articles, 27 studies were included for full review. The primary reason for exclusion was lack of protocol description, or lack of reporting on analgesic medications. No primary research studies specifically examined distress in the DCD eligible population. Numerous professional guidelines were identified. Surveys of critical care practitioners identified concerns regarding the impact of symptom management on hastening the dying process in the DCD population as a potential barrier to end-of-life palliative treatment. Conclusions There is a paucity of empirical evidence for end-of-life symptom assessment and management for DCD patients. Key evidence gaps identified for DCD include the need for: i) a multidisciplinary structure of treatment teams and preferred environment for DCD, ii) objective tools for monitoring of distress in this patient population, and iii) evidence guiding the administration of analgesic medications following withdrawal of life sustaining therapy.

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Section: Sedative and Analgesic Regimensmentioning

confidence: 99%

End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review

Cappucci

Smith

Schwartzstein

et al. 2022

The Neurohospitalist

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“…The goal of CE is to alleviate suffering and minimize respiratory distress at the end of life, as on average, death occurs within an hour after ventilator withdrawal. Despite the intent of easing suffering, a recent study showed that around 19%–30% of patients undergoing palliative ventilator withdrawal experience severe tachypnea (respiratory rate > 30 breaths/min) after CE [ 7 , 8 ]. This experience may create additional emotional stress for family members and healthcare providers.…”

Section: Introductionmentioning

confidence: 99%

Emotional impact of compassionate extubation on respiratory therapists and nurses: A pilot study

Kaur¹,

Chen²,

Faizi³

et al. 2022

Can J Respir Ther

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Background: Compassionate extubation (CE) refers to withdrawing mechanical ventilation and allowing a patient to die peacefully at the end of life. The primary objective of this pilot study was to quantify the emotional impact of CE on Respiratory Therapists (RT) and Registered Nurses (RNs). Methods: This pilot survey was conducted between March and April 2021 at an academic medical center among RTs and RNs. It included questions on participants' demographics, work characteristics, and Impact of Events (IES) scale to assess the subjective stress caused by CE. Data were analyzed using descriptive and χ 2 statistics. Results: Among 20 participants, 18 (90%) were females, 12 (60%) were in the 20-40-year age group, 12 (60%) were RTs, and 8 (40%) RNs. Around 15 (75%) participants worked day shifts with a weekly average of 3-4 shifts, and 14 (70%) performed/observed CE within 1 month before taking this survey. CE performed/observed in a month was ≤2 among 15 (75%) and 3-5 among 4 (20%) participants. Mean total IES score was 16.7 (12.3) among all participants representing 7 (35%) having low, 6 (30%) moderate, and 7 (35%) high emotional impact when performing CE. Risk of developing post-traumatic stress disorder (PTSD) was present in 6 (30%) participants. A significantly higher number of participants in the low impact group were satisfied with the institutional CE process (p = 0.043) than those in the medium/high impact group. Conclusion: This pilot study findings reveal that RTs and RNs experience moderate to high levels of subjective stress when performing CE. One-third of the survey participants were at risk of developing PTSD.

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“…5,6 Time to death varies based on the underlying disease pathology and may be accompanied by symptoms of the active dying including dyspnea, agitation, pain, anxiety, or copious oral secretions. 7-9…”

Section: Introductionmentioning

confidence: 99%

Palliative Ventilator Withdrawal Practices in an Inpatient Hospice Unit

Kaur

Harmon

Joseph

et al. 2022

Am J Hosp Palliat Care

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Background Palliative ventilator withdrawal (PVW) involves removal of mechanical ventilation in patients not expected to survive to allow a peaceful death. This process traditionally occurs in Intensive Care Units (ICU) and recently has evolved to occur in Inpatient Hospice and Palliative Care Units (IPU). Objectives To describe the process and response of patients undergoing PVW in an IPU setting. Methods This is a longitudinal observational cohort study of adult patients who underwent PVW in an IPU from January 2021 through March 2022. Results Among 25 enrolled subjects, median age was 68 (IQR 62.5-76.5) years and 14 (56%) were females. Median time from PVW to death was 16.8 (IQR 2.6-100) hours. A registered nurse and attending physician were present in all the cases, while a respiratory therapist was present in 20 (80%) and chaplain in 9 (36%) of the cases. Before PVW, opioids and benzodiazepines were administered to 24 (96%) patients. Post PVW, respiratory distress was noted among 16 (64%) patients and medication was given to 15 (60%) patients for respiratory distress. There was a significant association between the presence of respiratory distress and administration of medication within 30 minutes after PVW ( P = .009). The rituals performed during PVW were reciting prayers for 11 (44%), playing music for 8 (32%), and observing silence for 6 (24%) of the patients. Conclusion This study describes the PVW practices in an IPU setting where a multidisciplinary team was present during PVW for most of the cases and two-third of the patients undergoing PVW experienced respiratory distress immediately after PVW.

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Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Cited by 12 publications

References 71 publications

End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review

End-Of-Life Care in the Potential Donor after Circulatory Death: A Systematic Review

Emotional impact of compassionate extubation on respiratory therapists and nurses: A pilot study

Palliative Ventilator Withdrawal Practices in an Inpatient Hospice Unit

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