当前位置： SCI文献检索 > INTENSIVE CARE MEDICINE期刊下所有文献 > Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study.

Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study.

Abstract：

PURPOSE:Little is known on the incidence of discomfort during the end-of-life of intensive care unit (ICU) patients and the impact of sedation on such discomfort. The aim of this study was to assess the incidence of discomfort events according to levels of sedation. METHODS:Post-hoc analysis of an observational prospective multicenter study comparing immediate extubation vs. terminal weaning for end-of-life in ICU patients. Discomforts including gasps, significant bronchial obstruction or high behavioural pain scale score, were prospectively assessed by nurses from mechanical ventilation withdrawal until death. Level of sedation was assessed using the Richmond Agitation-Sedation Scale (RASS) and deep sedation was considered for a RASS - 5. Psychological disorders in family members were assessed up until 12 months after the death. RESULTS:Among the 450 patients included in the original study, 226 (50%) experienced discomfort after mechanical ventilation withdrawal. Patients with discomfort received lower doses of midazolam and equivalent morphine, and were less likely to have deep sedation than patients without discomfort (59% vs. 79%, p < 0.001). After multivariate logistic regression, extubation (as compared terminal weaning) was the only factor associated with discomfort, whereas deep sedation and administration of vasoactive drugs were two factors independently associated with no discomfort. Long-term evaluation of psychological disorders in family members of dead patients did not differ between those with discomfort and the others. CONCLUSION:Discomfort was frequent during end-of-life of ICU patients and was mainly associated with extubation and less profound sedation.

journal_name

Intensive Care Med

journal_title

Intensive care medicine

authors

Robert R,Le Gouge A,Kentish-Barnes N,Adda M,Audibert J,Barbier F,Bourcier S,Bourenne J,Boyer A,Devaquet J,Grillet G,Guisset O,Hyacinthe AC,Jourdain M,Lerolle N,Lesieur O,Mercier E,Messika J,Renault A,Vinatier I,Az

doi

10.1007/s00134-020-05930-w

subject

Has Abstract

pub_date

2020-06-01 00:00:00

pages

1194-1203

issue

eissn

0342-4642

issn

1432-1238

pii

10.1007/s00134-020-05930-w

journal_volume

pub_type

杂志文章

在线工具

Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study.