ArticleJournal of palliative medicine2013
Factors associated with palliative withdrawal of mechanical ventilation and time to death after withdrawal.
Article in Journal of palliative medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers, 1 of them a synthesis that pooled it.
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Who cites it
22 citing papers in PubMed, 1 synthesis or guideline pooled it, 81 citations in OpenAlex.
- Limitation of Life-Sustaining Care in the Critically Ill: A Systematic Review of the Literature.Journal of hospital medicine · 2019Pooled it
- Effectiveness of an Algorithmic Approach to Ventilator Withdrawal at the End of Life: A Stepped Wedge Cluster Randomized Trial.Journal of palliative medicine · 2024Trial
- Palliative extubation in intensive care units: scoping review.Revista da Escola de Enfermagem da U S P · 2026Article
- Withdrawal of Mechanical Ventilation in the Intensive Care Unit: A Prospective Observational Study.CHEST critical care · 2025Article
- How Long Do We Have? A Retrospective Review of Palliative Extubation in the Burn Unit.Journal of burn care & research : official publication of the American Burn Association · 2025Article
- Palliative General Anesthesia at Terminal Extubation: "Go Gentle into that Good Night".Neurocritical care · 2025Article
- Limitations of life-sustaining treatments in intensive care units in Croatia: a multicenter retrospective study.Croatian medical journal · 2024Article
- Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era.European journal of medical research · 2023Article
- Palliative extubation experience in a community hospital in southern Brazil.Revista da Associacao Medica Brasileira (1992) · 2023Article
- Predicting Time to Death After Withdrawal of Life-Sustaining Treatment in Children.Critical care explorations · 2022Review
- Emotional impact of compassionate extubation on respiratory therapists and nurses: A pilot study.Canadian journal of respiratory therapy : CJRT = Revue canadienne de la therapie respiratoire : RCTR · 2022Article
- Nurses' Experiences and Factors Related to Their Attitudes Regarding Discussions with Patients and Family Members about Do-Not-Resuscitate Decisions and Life-Sustaining Treatment Withdrawal: A Hospital-Based Cross-Sectional Study.International journal of environmental research and public health · 2020Article
- End-of-life decisions: A retrospective study in a tertiary care teaching hospital in India.The Indian journal of medical research · 2019Article
- Prognostication in critically ill patients with severe traumatic brain injury: the TBI-Prognosis multicentre feasibility study.BMJ open · 2017Article
- ICU physicians' and nurses' perceptions of terminal extubation and terminal weaning: a self-questionnaire study.Intensive care medicine · 2016Article
- Time to Death after Terminal Withdrawal of Mechanical Ventilation: Specific Respiratory and Physiologic Parameters May Inform Physician Predictions.Journal of palliative medicine · 2015Observational
- Predicting time to death after withdrawal of life-sustaining therapy.Intensive care medicine · 2015Review
- Compassionate extubation for a peaceful death in the setting of a community hospital: a case-series study.Clinical interventions in aging · 2015Article
- Family Physicians' Decision-making in Mechanical Ventilation Withdrawal: A Cross-sectional Study.Indian journal of palliative careArticle
- Mechanical ventilation withdrawal as a palliative procedure in a Brazilian intensive care unit.Revista Brasileira de terapia intensivaArticle
Corrections and comments
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Authors and funding
6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIn imminently dying patients, mechanical ventilation withdrawal is often a comfort measure and avoids prolonging the dying process.
objectiveThe aim of the study was to identify factors associated with palliative withdrawal of mechanical ventilation and time to death after extubation.
methodsLogistic regression models were used to identify factors associated with palliative withdrawal of mechanical ventilation. Cox proportional hazards models were used to determine factors associated with time to death after extubation. We retrospectively evaluated 322 patients who died on mechanical ventilation or after palliative ventilator withdrawal at a single tertiary care center.
resultsOf the 322 ventilated deaths, 159 patients had palliative withdrawal of mechanical ventilation and 163 patients died on the ventilator. Clinical service was associated with palliative withdrawal of mechanical ventilation: Patients withdrawn from the ventilator were less likely to be on the surgery service and more likely to be on the neurology/neurosurgical service. The median time to death was 0.9 hours (range 0-165 hours). Fraction of inspired oxygen (FIO2) greater than 70% (hazard ratio [HR] 1.92, 95% confidence interval [CI ]1.24-2.99) and a requirement for vasopressors (HR 2.06, 95% CI 1.38-3.09) were associated with shorter time to death. Being on the neurology/neurosurgical service at the time of ventilator withdrawal was associated with a longer time to death (HR 0.60, 95% CI 0.39-0.92).
conclusionsPalliative withdrawal of mechanical ventilation was performed in only half of dying mechanically ventilated patients. Because clinical service rather than physiologic parameters are associated with withdrawal, targeted interventions may improve withdrawal decisions. Considering FIO2 and vasopressor requirements may facilitate counseling families about anticipated time to death.
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