Fábio Holanda Lacerda1,2,3, Pedro Garcia Checoli1,4, Carla Marchini Dias da Silva1,2, Carlos Eduardo Brandão1,2, Daniel Neves Forte5, Bruno Adler Maccagnan Pinheiro Besen1,6. 1. Unidade de Terapia Intensiva, Hospital da Luz - São Paulo (SP), Brasil. 2. Unidade de Terapia Intensiva, AC Camargo Cancer Center - São Paulo (SP), Brasil. 3. Unidade de Terapia Intensiva, Hospital OTOclínica - Fortaleza (CE), Brasil. 4. Unidade de Terapia Intensiva, Hospital Sírio-Libanês - São Paulo (SP), Brasil. 5. Programa de Cuidados Paliativos, Hospital Sírio-Libanês - São Paulo (SP), Brasil. 6. Unidade de Terapia Intensiva, Disciplina de Emergências Clínicas, Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo - São Paulo, Brasil.
Abstract
OBJECTIVE: To describe the characteristics and outcomes of patients undergoing mechanical ventilation withdrawal and to compare them to mechanically ventilated patients with limitations (withhold or withdrawal) of life-sustaining therapies but who did not undergo mechanical ventilation withdrawal. METHODS: This was a retrospective cohort study from January 2014 to December 2018 of mechanically ventilated patients with any organ support limitation admitted to a single intensive care unit. We compared patients who underwent mechanical ventilation withdrawal and those who did not regarding intensive care unit and hospital mortality and length of stay in both an unadjusted analysis and a propensity score matched subsample. We also analyzed the time from mechanical ventilation withdrawal to death. RESULTS: Out of 282 patients with life-sustaining therapy limitations, 31 (11%) underwent mechanical ventilation withdrawal. There was no baseline difference between groups. Intensive care unit and hospital mortality rates were 71% versus 57% and 93% versus 80%, respectively, among patients who underwent mechanical ventilation withdrawal and those who did not. The median intensive care unit length of stay was 7 versus 8 days (p = 0.6), and the hospital length of stay was 9 versus 15 days (p = 0.015). Hospital mortality was not significantly different (25/31; 81% versus 29/31; 93%; p = 0.26) after matching. The median time from mechanical ventilation withdrawal until death was 2 days [0 - 5], and 10/31 (32%) patients died within 24 hours after mechanical ventilation withdrawal. CONCLUSION: In this Brazilian report, mechanical ventilation withdrawal represented 11% of all patients with treatment limitations and was not associated with increased hospital mortality after propensity score matching on relevant covariates.
OBJECTIVE: To describe the characteristics and outcomes of patients undergoing mechanical ventilation withdrawal and to compare them to mechanically ventilated patients with limitations (withhold or withdrawal) of life-sustaining therapies but who did not undergo mechanical ventilation withdrawal. METHODS: This was a retrospective cohort study from January 2014 to December 2018 of mechanically ventilated patients with any organ support limitation admitted to a single intensive care unit. We compared patients who underwent mechanical ventilation withdrawal and those who did not regarding intensive care unit and hospital mortality and length of stay in both an unadjusted analysis and a propensity score matched subsample. We also analyzed the time from mechanical ventilation withdrawal to death. RESULTS: Out of 282 patients with life-sustaining therapy limitations, 31 (11%) underwent mechanical ventilation withdrawal. There was no baseline difference between groups. Intensive care unit and hospital mortality rates were 71% versus 57% and 93% versus 80%, respectively, among patients who underwent mechanical ventilation withdrawal and those who did not. The median intensive care unit length of stay was 7 versus 8 days (p = 0.6), and the hospital length of stay was 9 versus 15 days (p = 0.015). Hospital mortality was not significantly different (25/31; 81% versus 29/31; 93%; p = 0.26) after matching. The median time from mechanical ventilation withdrawal until death was 2 days [0 - 5], and 10/31 (32%) patients died within 24 hours after mechanical ventilation withdrawal. CONCLUSION: In this Brazilian report, mechanical ventilation withdrawal represented 11% of all patients with treatment limitations and was not associated with increased hospital mortality after propensity score matching on relevant covariates.
Authors: Suzana M Lobo; Flávio H B De Simoni; Stephan M Jakob; Angel Estella; Sonali Vadi; Andreas Bluethgen; Ignacio Martin-Loeches; Yasser Sakr; Jean-Louis Vincent Journal: Chest Date: 2017-05-05 Impact factor: 9.410
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Authors: David J Lederer; Scott C Bell; Richard D Branson; James D Chalmers; Rachel Marshall; David M Maslove; David E Ost; Naresh M Punjabi; Michael Schatz; Alan R Smyth; Paul W Stewart; Samy Suissa; Alex A Adjei; Cezmi A Akdis; Élie Azoulay; Jan Bakker; Zuhair K Ballas; Philip G Bardin; Esther Barreiro; Rinaldo Bellomo; Jonathan A Bernstein; Vito Brusasco; Timothy G Buchman; Sudhansu Chokroverty; Nancy A Collop; James D Crapo; Dominic A Fitzgerald; Lauren Hale; Nicholas Hart; Felix J Herth; Theodore J Iwashyna; Gisli Jenkins; Martin Kolb; Guy B Marks; Peter Mazzone; J Randall Moorman; Thomas M Murphy; Terry L Noah; Paul Reynolds; Dieter Riemann; Richard E Russell; Aziz Sheikh; Giovanni Sotgiu; Erik R Swenson; Rhonda Szczesniak; Ronald Szymusiak; Jean-Louis Teboul; Jean-Louis Vincent Journal: Ann Am Thorac Soc Date: 2019-01