ArticleIntensive care medicine2020
Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study.
Article in Intensive care medicine, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
8 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Pain management during the withholding and withdrawal of life support in critically ill patients at the end-of-life: a systematic review and meta-analysis.Intensive care medicine · 2020Pooled it
- 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
- Palliative General Anesthesia at Terminal Extubation: "Go Gentle into that Good Night".Neurocritical care · 2025Article
- Comparing the Sedative Effect of Dexmedetomidine and Propofol in Mechanically Ventilated Patients Using Salivary Alpha-Amylase as a Stress Marker: A Randomized Open-Label Trial.Anesthesiology and pain medicine · 2024Article
- End-of-Life and Palliative Care in a Critical Care Setting: The Crucial Role of the Critical Care Pharmacist.Pharmacy (Basel, Switzerland) · 2022Article
- End of life in the critically ill patient: evaluation of experience of end of life by caregivers (EOLE study).Annals of intensive care · 2021Article
- Admission decisions to intensive care units in the context of the major COVID-19 outbreak: local guidance from the COVID-19 Paris-region area.Critical care (London, England) · 2020Article
Corrections and comments
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Authors and funding
24 authors.
Funding
Abstract
purposeLittle is known on the incidence of discomfort during the end-of-life of intensive care unit (ICU) patients and the impact of sedation on such discomfort. The aim of this study was to assess the incidence of discomfort events according to levels of sedation.
methodsPost-hoc analysis of an observational prospective multicenter study comparing immediate extubation vs. terminal weaning for end-of-life in ICU patients. Discomforts including gasps, significant bronchial obstruction or high behavioural pain scale score, were prospectively assessed by nurses from mechanical ventilation withdrawal until death. Level of sedation was assessed using the Richmond Agitation-Sedation Scale (RASS) and deep sedation was considered for a RASS - 5. Psychological disorders in family members were assessed up until 12 months after the death.
resultsAmong the 450 patients included in the original study, 226 (50%) experienced discomfort after mechanical ventilation withdrawal. Patients with discomfort received lower doses of midazolam and equivalent morphine, and were less likely to have deep sedation than patients without discomfort (59% vs. 79%, p < 0.001). After multivariate logistic regression, extubation (as compared terminal weaning) was the only factor associated with discomfort, whereas deep sedation and administration of vasoactive drugs were two factors independently associated with no discomfort. Long-term evaluation of psychological disorders in family members of dead patients did not differ between those with discomfort and the others.
conclusionDiscomfort was frequent during end-of-life of ICU patients and was mainly associated with extubation and less profound sedation.
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