Evidence map›Paper›PMID 32833041›Full record

SynthesisIntensive care medicine2020

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.

Andres Laserna, Alejandro Durán-Crane, María A López-Olivo, John A Cuenca, Cosmo Fowler, Diana Paola Díaz, Yenny R Cardenas, Catherine Urso, Keara O'Connell, Clara Fowler and 3 more

Open access · bronzeAbstract readMeta-AnalysisSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis 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.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
2.3field-weighted citation impact, top 11% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 19 citations in OpenAlex.

  1. Trial
  2. Article
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  4. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

13 authors at 5 institutions in 3 countries.

Andres LasernaDepartment of Anesthesiology and Perioperative Medicine, University of Rochester School of Medicine, Rochester, NY, USA.
Alejandro Durán-CraneDepartment of Internal Medicine, Cleveland Clinic, Cleveland, OH, USA.
María A López-OlivoDepartment of General Internal Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
John A CuencaDepartment of Critical Care, Division of Anesthesiology, Critical Care, and Pain, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Cosmo FowlerDepartment of Medicine, Case Western Reserve University-MetroHealth Medical Center, Cleveland, OH, USA.
Diana Paola DíazDepartment of Critical Care, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Yenny R CardenasDepartment of Critical Care, Hospital Universitario Fundación Santa Fe de Bogotá, Bogotá, Colombia.
Catherine UrsoDepartment of Critical Care, Division of Anesthesiology, Critical Care, and Pain, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Keara O'ConnellDepartment of Critical Care, Division of Anesthesiology, Critical Care, and Pain, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Clara FowlerResearch Services and Assessment, Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Kristen J PriceDepartment of Critical Care, Division of Anesthesiology, Critical Care, and Pain, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Charles L SprungDepartment of Anesthesiology and Critical Care Medicine, Faculty of Medicine, Hadassah Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel.
Joseph L NatesDepartment of Critical Care, Division of Anesthesiology, Critical Care, and Pain, The University of Texas MD Anderson Cancer Center, Houston, TX, USA. jlnates@mdanderson.org.ORCID 0000-0002-3190-3670
The University of Texas MD Anderson Cancer Center · USFundación Santa Fe de Bogotá · COCleveland Clinic · USHebrew University of Jerusalem · ILUniversity of Rochester · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeTo review and summarize the most frequent medications and dosages used during withholding and withdrawal of life-prolonging measures in critically ill patients in the intensive care unit.

methodsWe searched PubMed, EMBASE, the Cochrane Database of Systematic Reviews, and the Virtual Health Library from inception through March 2019. We considered any study evaluating pharmaceutical interventions for pain management during the withholding or withdrawing of life support in adult critically ill patients at the end-of-life. Two independent investigators performed the screening and data extraction. We pooled data on utilization rate of analgesic and sedative drugs and summarized the dosing between the moment prior to withholding or withdrawal of life support and the moment before death.

resultsThirteen studies met inclusion criteria. Studies were conducted in the United States (38%), Canada (31%), and the Netherlands (31%). Eleven studies were single-cohort and twelve had a Newcastle-Ottawa Scale score of less than 7. The mean age of the patients ranged from 59 to 71 years, 59-100% were mechanically ventilated, and 47-100% of the patients underwent life support withdrawal. The most commonly used opioid and sedative were morphine [utilization rate 60% (95% CI 48-71%)] and midazolam [utilization rate 28% (95% CI 23-32%)], respectively. Doses increased during the end-of-life process (pooled mean increase in the dose of morphine: 2.6 mg/h, 95% CI 1.2-4).

conclusionsPain control is centered on opioids and adjunctive benzodiazepines, with dosages exceeding those recommended by guidelines. Despite consistency among guidelines, there is significant heterogeneity among practices in end-of-life care.

Indexed as

Critical IllnessPain ManagementAdultAgedCanadaDeathHumansMiddle AgedNetherlandsCritically illEnd-of-lifePain managementTerminal care

Identifiers

PMID32833041
PMCPMC7444163
OpenAlexW3081158790

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.