Terminal weaning or immediate extubation for withdrawing mechanical ventilation in critically ill patients (the ARREVE observational study)

Abstract

ClinicalTrials.gov identifier: NCT01818895.

Bereavement care and research in the intensive care unit: Opportunities and challenges

“…Knowing these factors will help ICU teams improve the family's experience. Other studies show a similar prevalence of complicated grief symptoms at 6 months, ranging between 20% and 45% for complicated grief and 26% and 44% for PTSD . These studies show that perceptions of the quality of EOL care are significantly associated with complicated grief and PTSD, such as dissatisfaction with information and communication, unreasonable care, perception that the deceased person had not achieved a sense of completion about his or her life, presence at time of death, or discordance between family members' preferences for decision‐making and their actual decision‐making roles .…”

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

“…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. 30 Rapid weaning in cases when the patient may experience distress is recommended because this process affords an opportunity to restore the patient to a previous ventilator setting while their distress is relieved.…”

“…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. 30 Rapid weaning in cases when the patient may experience distress is recommended because this process affords an opportunity to restore the patient to a previous ventilator setting while their distress is relieved. The 1-step method is recommended only for unconscious patients who are unlikely to experience distress.…”

Life after death in the ICU: detecting family-centered outcomes remains difficult

“…This hypothesis is supported by evidence that ICU deaths are commonly preceded by decisions to withdraw life support [3], and evidence that both ICU processes of care [4,5] and behaviors of ICU clinicians [1,6] near the end of life can influence family members' post-ICU psychological outcomes. Thus, uncertainty regarding which approaches to withdrawing mechanical ventilation are least distressing for patients and families [7,8] represents an important area for rigorous investigation.In this context, Reignier and colleagues performed a prospective observational cohort study to compare psychological symptoms in over 400 family members of patients who died after withdrawal of mechanical ventilation by immediate extubation vs. terminal weaning in 43 French ICUs [9]. Impressively, the authors were able to assess the primary endpoint of PTSD symptoms 3 months after death among over 95% of enrolled family members.…”

“…In this context, Reignier and colleagues performed a prospective observational cohort study to compare psychological symptoms in over 400 family members of patients who died after withdrawal of mechanical ventilation by immediate extubation vs. terminal weaning in 43 French ICUs [9]. Impressively, the authors were able to assess the primary endpoint of PTSD symptoms 3 months after death among over 95% of enrolled family members.…”