ArticleCHEST critical care2025
Withdrawal of Mechanical Ventilation in the Intensive Care Unit: A Prospective Observational Study.
Article in CHEST critical care, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Authors and funding
9 authors.
Funding
Abstract
Background: Over 1 in 5 Americans die in intensive care units (ICUs), among whom 50% undergo palliative withdrawal of mechanical ventilation (WMV). Little is known about their experience or best practices to minimize their suffering. Research Question: To describe and identify factors associated with patient distress post-WMV. Study Design and Methods: Observational study of Withdrawal of Mechanical Ventilation (OBSERVE-WMV) is a prospective cohort study conducted from January 2021 to July 2022 in 12-ICUs at two academic medical centers among mechanically ventilated intubated patients transitioning to comfort-focused care via WMV. The cumulative incidence of experiencing distressful episodes from either observed respiratory distress (Respiratory distress observation score >3 or self-reported dyspnea rated ≥5), Pain (Visual Analog Scale or Clinical Pain Observation Tool ≥3), or agitation (Richmond Agitation Sedation Scale ≥+2) from the time of WMV initiation until death (or up to 3-hours post-WMV) were calculated. Multivariable Poisson Regression identified factors associated with the number of distressful episodes, adjusting for time at risk, generating adjusted incidence risk ratios (aIRRs) with 95% confidence intervals (CIs). Results: Among 153 participants, the cumulative incidence of at least one distressful episode post-WMV was 91% (individual symptoms were: respiratory distress, 90%; pain, 56%; and agitation, 5%), with 41% of patients having > 3 episodes. In multivariable analysis, receiving opiates within 1-hour before WMV (anticipatory dosing) was associated with lower risk of distressful episodes (aIRR 0.74, CI 0.55-0.99). Factors associated with higher risk of distressful episodes included: ICU stays > 10 days (aIRR 1.85, CI 1.20-2.88), lower levels of consciousness (lower Glasgow Coma Scale) (aIRR 1.72, CI 1.06-2.78), and distressful episodes pre-WMV (aIRR 1.63, CI 1.21-2.18). Interpretation: Nearly all ICU patients undergoing palliative WMV at end-of-life demonstrated distressful symptoms or signs. Anticipatory dosing with opiates prior to WMV may help mitigate their distress.
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