How to withdraw mechanical ventilation: a systematic review of the literature.

Eight published accounts about ventilator withdrawal spanning 1992-2004 were selected for review. Articles were selected if they contained data that described the processes comprising the withdrawal of mechanical ventilation as a terminal illness event. The purpose of this article is to synthesize the existing evidence about processes for the compassionate withdrawal of mechanical ventilation from intensive care unit patients, including measures of distress, premedication, medication during withdrawal, withdrawal methods, extubation considerations, duration of survival, and relationship of opioids or benzodiazepines to duration of survival. Practice recommendations will be suggested.