Terminal withdrawal of mechanical ventilation in adult intensive care units: A systematic review and narrative synthesis of perceptions, experiences and practices

被引:35
作者
Efstathiou, Nikolaos [1 ]
Vanderspank-Wright, Brandi [2 ]
Vandyk, Amanda [2 ]
Al-Janabi, Mustafa [2 ]
Daham, Zeinab [2 ]
Sarti, Aimee [3 ]
Delaney, Jesse W. [4 ]
Downar, James [5 ]
机构
[1] Univ Birmingham, Coll Med & Dent Sci, Sch Nursing, Inst Clin Sci, Birmingham, W Midlands, England
[2] Univ Ottawa, Fac Hlth Sci, Sch Nursing, Ottawa, ON, Canada
[3] Univ Ottawa, Dept Med, Div Crit Care, Ottawa, ON, Canada
[4] Rouge Valley Hlth Syst, Toronto, ON, Canada
[5] Univ Ottawa, Dept Med, Div Crit Care & Palliat Care, Ottawa, ON, Canada
关键词
Intensive care units; terminal weaning; terminal extubation; terminal withdrawal; life sustaining measures; systematic review; LIFE-SUPPORT; ICU PHYSICIANS; DEATH; END; TIME; EXTUBATION;
D O I
10.1177/0269216320935002
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: During the terminal withdrawal of life-sustaining measures for intensive care patients, the removal of respiratory support remains an ambiguous practice. Globally, perceptions and experiences of best practice vary due to the limited evidence in this area. Aim: To identify, appraise and synthesise the latest evidence around terminal withdrawal of mechanical ventilation in adult intensive care units specific to perceptions, experiences and practices. Design: Mixed methods systematic review and narrative synthesis. A review protocol was registered on PROSPERO (CRD42018086495). Data sources: Four electronic databases were systematically searched (Medline, Embase, CENTRAL and CINAHL). Obtained articles published between January 2008 and January 2020 were screened for eligibility. All included papers were appraised using relevant appraisal tools. Results: Twenty-five papers were included in the review. Findings from the included papers were synthesised into four themes: 'clinicians' perceptions and practices'; 'time to death and predictors'; 'analgesia and sedation practices'; 'physiological and psychological impact'. Conclusions: Perceptions, experiences and practices of terminal withdrawal of mechanical ventilation vary significantly across the globe. Current knowledge highlights that the time to death after withdrawal of mechanical ventilation is very short. Predictors for shorter duration could be considered by clinicians and guide the choice of pharmacological interventions to address distressing symptoms that patients may experience. Clinicians ought to prepare patients, families and relatives for the withdrawal process and the expected progression and provide them with immediate and long-term support following withdrawal. Further research is needed to improve current evidence and better inform practice guidelines.
引用
收藏
页码:1140 / 1164
页数:25
相关论文
共 45 条
[1]   Physicians' psychosocial barriers to different modes of withdrawal of life support in critical care: A qualitative study in Japan [J].
Aita, Kaoruko ;
Kai, Ichiro .
SOCIAL SCIENCE & MEDICINE, 2010, 70 (04) :616-622
[2]  
Aromataris E., 2017, Joanna Briggs Institute reviewers manual [Internet]
[3]   End of life management of adult patients in an Australian metropolitan intensive care unit: A retrospective observational study [J].
Bloomer, Melissa Jane ;
Tiruvoipati, Ravindranath ;
Tsiripillis, Michael ;
Botha, John A. .
AUSTRALIAN CRITICAL CARE, 2010, 23 (01) :13-19
[4]  
Boutron I, 2019, Cochrane Handbook for Systematic Reviews of Interventions, V2nd, P177, DOI DOI 10.1002/9781119536604.CH8
[5]   How to Withdraw Mechanical Ventilation A Systematic Review of the Literature [J].
Campbell, Margaret L. .
AACN ADVANCED CRITICAL CARE, 2007, 18 (04) :397-403
[6]   A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing [J].
Campbell, Margaret L. ;
Yarandi, Hossein N. ;
Mendez, Michael .
JOURNAL OF PALLIATIVE MEDICINE, 2015, 18 (09) :781-785
[7]   Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU [J].
Cooke, Colin R. ;
Hotchkin, David L. ;
Engelberg, Ruth A. ;
Rubinson, Lewis ;
Curtis, J. Randall .
CHEST, 2010, 138 (02) :289-297
[8]   Challenges in transition from intervention to end of life care in intensive care: A qualitative study [J].
Coombs, Maureen A. ;
Addington-Hall, Julia ;
Long-Sutehall, Tracy .
INTERNATIONAL JOURNAL OF NURSING STUDIES, 2012, 49 (05) :519-527
[9]   ICU physicians' and nurses' perceptions of terminal extubation and terminal weaning: a self-questionnaire study [J].
Cottereau, Alice ;
Robert, Rene ;
le Gouge, Amelie ;
Adda, Melanie ;
Audibert, Juliette ;
Barbier, Francois ;
Bardou, Patrick ;
Bourcier, Simon ;
Boyer, Alexandre ;
Brenas, Francois ;
Canet, Emmanuel ;
Da Silva, Daniel ;
Das, Vincent ;
Desachy, Arnaud ;
Devaquet, Jerome ;
Embriaco, Nathalie ;
Eon, Beatrice ;
Feissel, Marc ;
Friedman, Diane ;
Ganster, Frederique ;
Garrouste-Orgeas, Maite ;
Grillet, Guillaume ;
Guisset, Olivier ;
Guitton, Christophe ;
Hamidfar-Roy, Rebecca ;
Hyacinthe, Anne-Claire ;
Jochmans, Sebastien ;
Lion, Fabien ;
Jourdain, Merce ;
Lautrette, Alexandre ;
Lerolle, Nicolas ;
Lesieur, Olivier ;
Mateu, Philippe ;
Megarbane, Bruno ;
Mercier, Emmanuelle ;
Messika, Jonathan ;
Morin-Longuet, Paul ;
Philippon-Jouve, Benedicte ;
Quenot, Jean-Pierre ;
Renault, Anne ;
Repesse, Xavier ;
Rigaud, Jean-Philippe ;
Robin, Segolene ;
Roquilly, Antoine ;
Seguin, Amelie ;
Thevenin, Didier ;
Tirot, Patrice ;
Contentin, Laetitia ;
Kentish-Barnes, Nancy ;
Reignier, Jean .
INTENSIVE CARE MEDICINE, 2016, 42 (08) :1248-1257
[10]  
Covidence systematic review software, COV SYST REV SOFTW