Withdrawal of Life-Sustaining Treatment

Abstract

Withdrawal of life support is an option for patients with prolonged mechanical ventilation when all attempts at weaning have failed and it is deemed futile to continue the therapy, when quality of life is unacceptable, or when it is perceived that the patient is suffering. The purpose of this article is to present the nursing aspects of managing an adult patient undergoing the withdrawal of mechanical ventilation as an end-of-life procedure. Withdrawal of mechanical ventilation is a complex and difficult process that requires meticulous planning and management. Conferences with the patient and the patient’s family are critical to addressing emotional support and ensuring that everyone understands the process and is provided an opportunity to gather information. Clear communication with patients and their families can ensure that the process goes smoothly. Having an organized approach can ensure that patients experience a peaceful death and staff experience closure regarding the event.

Certainty and uncertainty about end of life care nursing practices in New Zealand Intensive Care Units: A mixed methods study

“…The bedside nurse is also central to undertaking aspects of the treatment withdrawal process. 18 This includes symptom management and the weaning and withdrawal of specific therapies e.g. mechanical ventilation.…”

Palliative withdrawal ventilation: why, when and how to do it?

“…The aim of the first meeting is to establish the irreversibility of the patient's clinical condition, rule out possible additional therapeutic options, and achieve a consensus as to the indication for palliative extubation. 2 The meeting should be attended by the staff members who provide care to the patient, particularly physicians, nurses, psychologists and physical therapists.…”

“…The full diagnostic and therapeutic process should be reviewed with the patient and family. 2,11,12 The patient's values, beliefs and explicit desires stated while conscious should be understood and taken into account, and this time of active attention to their desires should be considered as a crucial part of the meeting.…”

“…It is also an option when the patient's quality of life is unacceptable and without any hope of improvement or when it becomes clear that support is causing unnecessary suffering. 2 These notions should be reinforced such that palliative extubation not to be seen as a way to accelerate death and should not be performed when the assessment of the irreversibility of the patient's condition is incomplete or inadequate. Direct patient benefit is always the essential goal of palliative extubation, thereby avoiding subjecting patients to suffering incommensurate with their actual situation.…”

“…Palliative extubation is a complex procedure that demands clearly defined and meticulous planning, including clear communication among all the actors involved. 2 Inadequate planning may result in significant suffering for patients and may cause symptoms such as severe pain or dyspnea following extubation in addition to significantly increasing the risk of difficult bereavement for the attending family members. However, despite the relevance of adequate planning and execution, the literature provides little information on how to perform palliative extubation properly.…”