Palliative Ventilator Withdrawal Practices in an Inpatient Hospice Unit

Abstract

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.

Palliation, end of life care and ventilation withdrawal in neuromuscular disorders

“…Experience is growing in paediatric and adult services around withdrawal of ventilator support in different settings including hospital, hospice and home. 87 , 92 – 95 …”

“…Experience is growing in paediatric and adult services around withdrawal of ventilator support in different settings including hospital, hospice and home. 87,[92][93][94][95] The Association of Palliative Medicine have produced clear guidelines on ventilator withdrawal for patients with MND, to achieve symptom control in the period between NIV withdrawal and death. 13,96 In Paediatric palliative care, guidance has also been developed.…”

Aspectos éticos da aplicação de ventilação mecânica em cuidados paliativos nas Unidades de Terapia Intensiva: uma revisão narrativa

“…Somente através de uma abordagem tão completa e matizada pode-se esperar tomar decisões éticas e clinicamente apropriadas em um contexto tão desafiador e sensível (Wiegand, Cheon e Netzer, 2019). Contribuciones a Las Ciencias Sociales, São José dos Pinhais, v.17 O uso de ventilação mecânica em ambientes de cuidados paliativos nas Unidades de Terapia Intensiva (UTI) é regido por uma série de políticas de saúde e diretrizes clínicas que visam padronizar a prática médica e otimizar o uso de recursos (Kaur et al, 2023). Este texto explora como essas políticas e diretrizes podem influenciar a decisão clínica, considerando tanto a alocação de recursos como a eficácia clínica.…”