Predictors of time to death after terminal withdrawal of mechanical ventilation in the ICU

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU.
CHEST August 2010 vol. 138 (2), p. 289-297

Cooke, C.R., et al.

http://chestjournal.chestpubs.org/content/138/2/289.short?rss=1

Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. This study seeks to determine the independent predictors of time to death after withdrawal of mechanical ventilation.

Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. New England Journal of Medicine, vol. 349(12), Sept. 2003. [journal article]

Cook, D., et al.

http://content.nejm.org/cgi/reprint/349/12/1123.pdf

In critically ill patients who are receiving mechanical ventilation, the factors associated with physicians’ decisions to withdraw ventilation in anticipation of death are unclear. The objective of this study was to examine the clinical determinants that were associated with the withdrawal of mechanical ventilation.

Death, empathy and self preservation: the emotional labour of caring for families of the critically ill in adult intensive care

Death, empathy and self preservation: the emotional labour of caring for families of the critically ill in adult intensive care
Louise Caroline Stayt
Abstract
Published Online: 8 Apr 2009DOI 10.1111/j.1365-2702.2008.02712.x

Close relatives' experiences of caring and of the physical environment when a loved one dies in an ICU.

Close relatives' experiences of caring and of the physical environment when a loved one dies in an ICU.
Fridh I, Forsberg A, Bergbom I.Intensive Crit Care Nurs. 2008 Dec 26. [Epub ahead of print]PMID: 19112022 [PubMed - as supplied by publisher]Related Articles

Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment

Wednesday, October 22, 2008

Extract from http://runningahospital.blogspot.com/

Associations Between End-of-Life Discussions, Patient Mental Health, Medical Care Near Death, and Caregiver Bereavement Adjustment

Alexi A. Wright, MD; Baohui Zhang, MS; Alaka Ray, MD; Jennifer W. Mack, MD, MPH; Elizabeth Trice, MD, PhD; Tracy Balboni, MD, MPH; Susan L. Mitchell, MD; Vicki A. Jackson, MD, MPH; Susan D. Block, MD; Paul K. Maciejewski, PhD; Holly G. Prigerson, PhDJAMA. 2008;300(14):1665-1673.
Context
Talking about death can be difficult. Without evidence that end-of-life discussions improve patient outcomes, physicians must balance their desire to honor patient autonomy against a concern of inflicting psychological harm.

Objective: To determine whether end-of-life discussions with physicians are associated with fewer aggressive interventions.Design, Setting, and ParticipantsA US multisite, prospective, longitudinal cohort study of patients with advanced cancer and their informal caregivers (n = 332dyads), September 2002-February 2008. Patients were followed up from enrollment to death, a median of 4.4 months later. Bereaved caregivers' psychiatric illness and quality of life was assessed a median of 6.5 months later.

Main Outcome Measures Aggressive medical care (eg, ventilation, resuscitation) and hospice in the final week of life. Secondary outcomes included patients' mental health and caregivers' bereavement adjustment.ResultsOne hundred twenty-three of 332 (37.0%) patients reported having end-of-life discussions before baseline.... After propensity-score weighted adjustment, end-of-life discussions were associated with lower rates of ventilation... resuscitation ... ICU admission ... and earlier hospice enrollment. In adjusted analyses, more aggressive medical care was associated with worse patient quality of life ... and higher risk of major depressive disorder in bereaved caregivers ... whereas longer hospice stays were associated with better patient quality of life .... Better patient quality of life was associated with better caregiver quality of life at follow-up....

Conclusions
End-of-life discussions are associated with less aggressive medical care near death and earlier hospice referrals. Aggressive care is associated with worse patient quality of life and worse bereavement adjustment.

Posted by Paul Levy at 10/22/2008 08:11:00 PM 3 comments

A phenomenological study to understand the experiences of nurses with regard to brainstem death.

Ronayne C. Related Articles, LinkOut

Intensive Crit Care Nurs. 2008 Jul 24; [Epub ahead of print] PMID: 18657425 [PubMed - as supplied by publisher]

Informing Critical Care Patients of a Loved One's Death

Author(s): Watson , L . A . P . Critical Care Nurse
ISSUE: 2008 ; VOL 28 ; PART 3
Access: From EBSCO ( CINAHL with Full Text ) - via Athens [Full Text] (10/2002 - /)

From Free Medical Journals . com From Proquest NHS (04/1998 - 04/2007)
Page: 52-64
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Is Withholding Life Support Associated With a Premature Death ? : If So , What Does This Mean for ICU Practice ?

Author(s): Helene Starks
ISSUE: 2008 ; VOL 133 ; PART 6 (2008-June)
Journal Title: Chest ( Formerly : Diseases of the Chest ) From Free Medical Journals . com (/1995 - /Embargo: 1 year) Customer Notes: 1997 v111/1 - Print Location: Macclesfield

From Proquest NHS (01/1997 - 11/2006)
Page: 1298 - 1300
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Managing a good death in critical care : can health policy help ?

Author(s): Maureen Coombs ; Tracy Long
ISSUE: 2008 ; VOL 13 ; PART 4 (July and August 2008)
Journal Title: Nursing in Critical Care From EBSCO ( CINAHL with Full Text ) - via Athens (01/2003 - /Embargo: 12 months)
Page: 208-214
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Nursing in Critical Care: Volume 13 Issue 4 (July and August 2008)

You will need your Athens details.

Guest Editorials
Critical care nursing: towards 2015 (p 181-183)
Published Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00287.x
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The impact of the impact factor on publication in critical care nursing (p 184-184)
Published Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00288.x
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Research
Experiences of intensive care nurses assessing sedation/agitation in critically ill patients
(p 185-194)
Stephanie Weir, Anna O'NeillPublished Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00282.x
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Article
Delirium and use of sedation agents in intensive care (p 195-202)Richard S. BournePublished Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00278.x
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Practice Developments
Implementing a ventilator care bundle in an adult intensive care unit (p 203-207)Samantha WestwellPublished Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00279.x
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Managing a good death in critical care: can health policy help? (p 208-214)Maureen Coombs, Tracy LongPublished Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00280.x
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Thinking Outside the Box
Commentary: Jackson JC et al. (2007). Post-traumatic stress disorder and post-traumatic stress symptoms following critical illness in medical intensive care unit patients: assessing the magnitude of the problem (p 215-217)Janice RattrayPublished Online: Jun 28 2008 6:35AMDOI: 10.1111/j.1478-5153.2008.00284.x
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Predicting death and readmission after intensive care discharge

Campbell AJ, Cook JA, Adey G, Cuthbertson BH.
Department of Anaesthesia, Western Infirmary, Glasgow G11 6NT, UK. alison.campbell3@nhs.net

BACKGROUND: Despite initial recovery from critical illness, many patients deteriorate after discharge from the intensive care unit (ICU). We examined prospectively collected data in an attempt to identify patients at risk of readmission or death after intensive care discharge.

METHODS: This was a secondary analysis of clinical audit data from patients discharged alive from a mixed medical and surgical (non-cardiac) ICU. RESULTS: Four hundred and seventy-five patients (11.2%) died in hospital after discharge from the ICU. Increasing age, time in hospital before intensive care admission, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, and discharge Therapeutic Intervention Scoring System (TISS) score were independent risk factors for death after intensive care discharge. Three hundred and eighty-five patients (8.8%) were readmitted to intensive care during the same hospital admission. Increasing age, time in hospital before intensive care, APACHE II score, and discharge to a high dependency unit were independent risk factors for readmission. One hundred and forty-three patients (3.3%) were readmitted within 48 h of intensive care discharge. APACHE II scores and discharge to a high dependency or other ICU were independent risk factors for early readmission. The overall discriminant ability of our models was moderate with only marginal benefit over the APACHE II scores alone.

CONCLUSIONS: We identified risk factors associated with death and readmission to intensive care. It was not possible to produce a definitive model based on these risk factors for predicting death or readmission in an individual patient.

The quality of dying and death

Arch Intern Med. 2008 May 12;168(9):912-8. Related Articles, Links Hales S, Zimmermann C, Rodin G.

Department of Psychosocial Oncology & Palliative Care, Princess Margaret Hospital, University Health Network, Toronto, Ontario, Canada. sarah.hales@uhn.on.ca

During the past decade, research has examined definitions and conceptualizations of quality of dying and death in different populations. At the same time, there has been a call to clarify the distinctions between quality of dying and death and other end-of-life constructs. The purposes of this article are to (1) review research that examined definitions and conceptualizations of the quality of dying and death, (2) clarify the quality of dying and death construct and its distinction from quality of life and quality of care at the end of life, and (3) outline challenges that remain for health care professionals, researchers, and policy makers. Review of the literature revealed that the quality of dying and death construct is multidimensional, with 7 broad domains: physical experience, psychological experience, social experience, spiritual or existential experience, the nature of health care, life closure and death preparation, and the circumstances of death. The quality of dying and death is subjectively determined with numerous factors that influence its judgment, including culture, type and stage of disease, and social and professional role in the dying experience.
Quality of dying and death is broader in scope than either quality of life at the end of life or quality of care at the end of life, although there is overlap among these constructs.Publication Types:
Research Support, Non-U.S. Gov't
PMID: 18474754 [PubMed - in process]

Continuous deep sedation in patients nearing death
Author(s): Scott A Murray
ISSUE: 2008 ; VOL 336 ; PART 7648 (2008-April-12)
Journal Title: Bmj . British Medical Journal - International Edition From Publisher (01/1994 - /)

From Free Medical Journals . com (/1994 - /Embargo: 1 year)
From Proquest NHS (01/1994 - 12/2003)
Page: 781 - 782
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BMJ articles: Deep sedation and others ....

RAPID RESPONSES
Continuous deep sedation in patients nearing death - read research paper and accompanying editorial.

Rapid responses to these two articles:
A term impossible to define?
Helpful article
Dutch research reflects problems with the Liverpool Care Pathway
Painless death
The dying patient. Stratifying sedation
Caution
Professionals should not feel they are shortening life with sedation

Liver histology in ICU patients dying from sepsis : A clinico - pathological study

Author(s): Koskinas J . ; Gomatos I . P . ; Tiniakos D . G . ; Memos N . ; Boutsikou M . ; Garatzioti A . ; Archimandritis A . ; Betrosian A .
ISSUE: 2008 ; VOL 14 ; PART 9 (03-07-2008)
Journal Title: World Journal of Gastroenterology From Free Medical Journals . com (/1995 - /)
Page: 1389-1393
ISSN: Print: 1007-9327
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Analysis of the risk factors of death in the patients with sepsis
Author(s): Zhu , Y . ; Zhou , Q . ; Huang , H .
ISSUE: 2008 ; VOL 28 ; PART 1
Journal Title: Chinese Journal of Critical Care Medicine Chinese Journal of Critical Care Medicine Page: 24-27
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BMJ: 12 April 2008

News articles:

Are doctors heartless about death?
Jerome P Kassirer

The self critical doctor: helping students become more reflective
Erik Driessen, Jan van Tartwijk, and Tim Dornan

Doctors are mostly happy in their work, but concerned at staffing levels, survey shows
Lynn Eaton

UK doctors show most interest in falls among elderly people, but French more curious about type 2 diabetes
Roger Dobson

BMA asks government to support campaign for more consultants
Lynn Eaton

Exhibition explores the last taboo: death
Zosia Kmietowicz

BMA angered by below inflation pay offer
Lynn Eaton

BMJ Table of Contents: 12 April

Continuous deep sedation in patients nearing death
Scott A Murray, Kirsty Boyd, and Ira Byock

Cardiopulmonary resuscitation for out of hospital cardiac arrest
Jasmeet Soar and Jerry P Nolan

Oral bisphosphonates and atrial fibrillation
Sumit R Majumdar

Selecting medical students
Celia A Brown and Richard J Lilford

Crital Care Editorials and Letters: Vol 36 Issue 4

Editorials
1357-1358
Validating predictive models of mortality: More than meets the eye
Andrew A. Kramer, PhD

1358-1360
Lung-protective higher frequency oscillatory ventilation
Stephen Derdak, DO

1360-1361
Clinical practice guidelines: Culture eats strategy for breakfast, lunch, and dinner
I Alan Fein, MD, MPH; Robert R. Corrato, MD, MBA

1361-1363
Bull’s eye missed by the magic bullet: Preclinical investigations, publication bias, and promising new interventions
Jyrki J. Tenhunen, MD, PhD

1363-1364
Donation after cardiac death: Should we fear the reaper?
David Crippen, MD, FCCM

1364-1366
End-of-life organ donation for transplantation: Stretching the ethical and legal boundaries of medical practice in society
Joseph L. Verheijde, MBA, PhD; Mohamed Y. Rady, MD, PhD; Joan L. McGregor, PhD

1366-1367
Role of sedation and analgesia in mechanical ventilation
Graziano C. Carlon, MD; Arthur Combs, MD

1368-1369
“The truth, if it exists, is in the details”
David Gilbert, MD

1369-1370
The generic septic response
Donald E. Fry, MD, FACS

1370-1372
Redefine acute renal failure? Not yet, thanks
Lawrence S. Weisberg, MD; Jean-Sebastien Rachoin, MD

1372-1373
The search for a good death—Are there quality insights accessible from medical records?
Richard A. Mularski, MD, MSHS, MCR

1374-1375
Monkey see, monkey do: Adhering to scientific principles
M Susan Mandell, MD, PhD

1375-1376
The latest in resting energy expenditure prediction: New! Improved! Better?
Marc J. Popovich, MD, FCCM

1378-1379
Since when did sedatives start to save lives?
Huang-Ping Yu, MD, PhD; Ying-Tung Lau, PhD

1380-1381
Electrical impedance tomography—A new toy for boys or the future for mechanically ventilated patients?
Marcus J. Schultz, MD, PhD, FCCP

1381-1382
Critical illness myopathy: A direct role for endotoxin
G Bryan Young, MD, FRCPC

1382-1383
Investigating the role of bacterial zinc-containing metalloproteases in the pathogenesis of complicated pneumococcal pneumonia
Michael Eisenhut

1383-1384
Right data, wrong conclusions
Giora Netzer, MD, MSCE; Richard P. Dutton, MD, MBA; John R. Hess, MD, MPH

1385-1386
Critical care workforce crisis: Time to look in the mirror
Mark A. Kelley, MD

Letters to the Editors
1387
From “inconvenient truth” to “assault on reason”
Marcus J. Schultz, MD, PhD; Mart J. de Graaff; Michael A. Kuiper; Peter E. Spronk

1387
From “inconvenient truth” to “assault on reason”
James S. Krinsley, MD, FCCM; Aarti Grover, MD

1387-1388
Not euthanasia, simply compassionate clinical care
Robert D. Truog, MD

1388
Euthanasia in the critical care setting
Alberto Giannini, MD

1389
Euthanasia in the critical care setting
Erwin J. O. Kompanje, PhD; Inez D. de Beaufort, PhD; Jan Bakker, MD, PhD

1390
Severe hypoglycemia in critically ill: Risk and outcomes
T M. Vriesendorp, MD, PhD; J H. DeVries, MD, PhD; F Rosendaal, MD, PhD; J B. L. Hoekstra, MD, PhD

1390-1391
Severe hypoglycemia in critically ill: Risk and outcomes
James S. Krinsley, MD, FCCM; Aarti Grover, MD

1391
Tight glucose control and hypoglycemia
Jean-Charles Preiser, MD, PhD; Frank Brunkhorst

1391-1392
Tight glucose control and hypoglycemia
James S. Krinsley, MD, FCCM; Aarti Grover, MD

1392
Acid base balances
George John, MBBS, MD, FRACP, FJFICM

1392
Acid base balances
John A. Kellum, MD, FCCM

Book Review
1393
Manual of Overdoses and Poisons
James H. Diaz, MD, MPH, DrPH, FCCP, FAAP, FCCM