The Use of Opioids and Sedatives and Time Until Death After Withdrawing Mechanical Ventilation and Vasoactive Drugs in a Dutch Intensive Care Unit

Abstract

Dutch patients who die in the ICU, or die after discharge from the ICU, die after MV and/or VAs are withdrawn. When treatments are withdrawn, death follows within 1 hour in most patients, which is a reflection of the severity of illnesses. At least 80% of patients receive opioids, and 67% receive sedatives until death. Fentanyl is the most used opioid, whereas midazolam is the most used sedative. Dosages of opioids and sedatives did not significantly exceed the ranges described as usual in the international literature.

Withdrawal of Life-Sustaining Treatment in a Mixed Intensive Care Unit: Most Common in Patients with Catastropic Brain Injury

“…A noticeable difference compared with the USA, where such decisions are made by the responsible physician in collaboration with family members or a surrogate decision maker of the patient [19,22]. When treatment is believed to be futile by the multidisciplinary team, in most cases treatment is withdrawn rather than withheld [23]. Among patients in whom treatment was withdrawn, a large percentage of patients with severe CNS failure were presented.…”

Respiratory support withdrawal in intensive care units: international differences stressed and straightened!

“…This statement is not in concordance with our own experience. The withdrawal rate in our Dutch ICU is 83% of the patients who died in the ICU [3]. This result is fully supported by the ETHICUS (Ethics in European Intensive Care Units) study, which reported that withdrawal of treatment is a generally accepted form of end-of-life care in Europe, especially in Northern Europe [4].…”

Sedatives and Analgesics Given to Infants in Neonatal Intensive Care Units at the End of Life

“…2,5,39 In a study of 60 adult patients in a Dutch intensive care unit, 80% received opioids and 67% received sedatives during withdrawal of life support. 40 Those who did not receive drugs were more likely to have acutely devastating neurologic disease. 40 …”

“…40 Those who did not receive drugs were more likely to have acutely devastating neurologic disease. 40 …”