BACKGROUND: Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. We sought to determine the independent predictors of time to death after withdrawal of mechanical ventilation. METHODS: We conducted a secondary analysis from a cluster randomized trial of an end-of-life care intervention. We studied 1,505 adult patients in 14 hospitals in Washington State who died within or shortly after discharge from an ICU following terminal withdrawal of mechanical ventilation (August 2003 to February 2008). Time to death and its predictors were abstracted from the patients' charts and death certificates. Predictors included demographics, proxies of severity of illness, life-sustaining therapies, and International Classification of Diseases, 9th ed., Clinical Modification codes. RESULTS: The median (interquartile range [IQR]) age of the cohort was 71 years (58-80 years), and 44% were women. The median (IQR) time to death after withdrawal of ventilation was 0.93 hours (0.25-5.5 hours). Using Cox regression, the independent predictors of a shorter time to death were nonwhite race (hazard ratio [HR], 1.17; 95% CI, 1.01-1.35), number of organ failures (per-organ HR, 1.11; 95% CI, 1.04-1.19), vasopressors (HR, 1.67; 95% CI, 1.49-1.88), IV fluids (HR, 1.16; 95% CI, 1.01-1.32), and surgical vs medical service (HR, 1.29; 95% CI, 1.06-1.56). Predictors of longer time to death were older age (per-decade HR, 0.95; 95% CI, 0.90-0.99) and female sex (HR, 0.86; 95% CI, 0.77-0.97). CONCLUSIONS: Time to death after withdrawal of mechanical ventilation varies widely, yet the majority of patients die within 24 hours. Subsequent validation of these predictors may help to inform family counseling at the end of life.
RCT Entities:
BACKGROUND: Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. We sought to determine the independent predictors of time to death after withdrawal of mechanical ventilation. METHODS: We conducted a secondary analysis from a cluster randomized trial of an end-of-life care intervention. We studied 1,505 adult patients in 14 hospitals in Washington State who died within or shortly after discharge from an ICU following terminal withdrawal of mechanical ventilation (August 2003 to February 2008). Time to death and its predictors were abstracted from the patients' charts and death certificates. Predictors included demographics, proxies of severity of illness, life-sustaining therapies, and International Classification of Diseases, 9th ed., Clinical Modification codes. RESULTS: The median (interquartile range [IQR]) age of the cohort was 71 years (58-80 years), and 44% were women. The median (IQR) time to death after withdrawal of ventilation was 0.93 hours (0.25-5.5 hours). Using Cox regression, the independent predictors of a shorter time to death were nonwhite race (hazard ratio [HR], 1.17; 95% CI, 1.01-1.35), number of organ failures (per-organ HR, 1.11; 95% CI, 1.04-1.19), vasopressors (HR, 1.67; 95% CI, 1.49-1.88), IV fluids (HR, 1.16; 95% CI, 1.01-1.32), and surgical vs medical service (HR, 1.29; 95% CI, 1.06-1.56). Predictors of longer time to death were older age (per-decade HR, 0.95; 95% CI, 0.90-0.99) and female sex (HR, 0.86; 95% CI, 0.77-0.97). CONCLUSIONS: Time to death after withdrawal of mechanical ventilation varies widely, yet the majority of patients die within 24 hours. Subsequent validation of these predictors may help to inform family counseling at the end of life.
Authors: Patsy D Treece; Ruth A Engelberg; Sarah E Shannon; Elizabeth L Nielsen; Theresa Braungardt; Gordon D Rubenfeld; Kenneth P Steinberg; J Randall Curtis Journal: Crit Care Med Date: 2006-11 Impact factor: 7.598
Authors: J Randall Curtis; Ruth A Engelberg; Marjorie D Wenrich; Elizabeth L Nielsen; Sarah E Shannon; Patsy D Treece; Mark R Tonelli; Donald L Patrick; Lynne S Robins; Barbara B McGrath; Gordon D Rubenfeld Journal: J Crit Care Date: 2002-09 Impact factor: 3.425
Authors: D J Cook; G Guyatt; G Rocker; P Sjokvist; B Weaver; P Dodek; J Marshall; D Leasa; M Levy; J Varon; M Fisher; R Cook Journal: Lancet Date: 2001-12-08 Impact factor: 79.321
Authors: Charles L Sprung; Simon L Cohen; Peter Sjokvist; Mario Baras; Hans-Henrik Bulow; Seppo Hovilehto; Didier Ledoux; Anne Lippert; Paulo Maia; Dermot Phelan; Wolfgang Schobersberger; Elisabet Wennberg; Tom Woodcock Journal: JAMA Date: 2003-08-13 Impact factor: 56.272
Authors: Deborah Cook; Graeme Rocker; John Marshall; Peter Sjokvist; Peter Dodek; Lauren Griffith; Andreas Freitag; Joseph Varon; Christine Bradley; Mitchell Levy; Simon Finfer; Cindy Hamielec; Joseph McMullin; Bruce Weaver; Stephen Walter; Gordon Guyatt Journal: N Engl J Med Date: 2003-09-18 Impact factor: 91.245
Authors: Laveena Munshi; Sonny Dhanani; Sam D Shemie; Laura Hornby; Genevieve Gore; Jason Shahin Journal: Intensive Care Med Date: 2015-05-06 Impact factor: 17.440
Authors: Renee D Stapleton; Dee W Ford; Katherine R Sterba; Nandita R Nadig; Steven Ades; Anthony L Back; Shannon S Carson; Katharine L Cheung; Janet Ely; Erin K Kross; Robert C Macauley; Jennifer M Maguire; Theodore W Marcy; Jennifer J McEntee; Prema R Menon; Amanda Overstreet; Christine S Ritchie; Blair Wendlandt; Sara S Ardren; Michael Balassone; Stephanie Burns; Summer Choudhury; Sandra Diehl; Ellen McCown; Elizabeth L Nielsen; Sudiptho R Paul; Colleen Rice; Katherine K Taylor; Ruth A Engelberg Journal: J Pain Symptom Manage Date: 2022-06 Impact factor: 5.576
Authors: Bertrand Guidet; Hans Flaatten; Ariane Boumendil; Alessandro Morandi; Finn H Andersen; Antonio Artigas; Guido Bertolini; Maurizio Cecconi; Steffen Christensen; Loredana Faraldi; Jesper Fjølner; Christian Jung; Brian Marsh; Rui Moreno; Sandra Oeyen; Christina Agwald Öhman; Bernardo Bollen Pinto; Ivo W Soliman; Wojciech Szczeklik; Andreas Valentin; Ximena Watson; Tilemachos Zafeiridis; Dylan W De Lange Journal: Intensive Care Med Date: 2018-05-17 Impact factor: 17.440
Authors: Thanh N Huynh; Anne M Walling; Thuy X Le; Eric C Kleerup; Honghu Liu; Neil S Wenger Journal: J Palliat Med Date: 2013-10-01 Impact factor: 2.947
Authors: Ann C Long; Sarah Muni; Patsy D Treece; Ruth A Engelberg; Elizabeth L Nielsen; Annette L Fitzpatrick; J Randall Curtis Journal: J Palliat Med Date: 2015-11-10 Impact factor: 2.947