Abstract:
BACKGROUND:Discussions about withdrawal of life-sustaining therapies often include family members of critically ill patients. These conversations should address essential components of the dying process, including expected time to death after withdrawal. OBJECTIVES:The study objective was to aid physician communication about the dying process by identifying predictors of time to death after terminal withdrawal of mechanical ventilation. METHODS:We conducted an observational analysis from a single-center, before-after evaluation of an intervention to improve palliative care. We studied 330 patients who died after terminal withdrawal of mechanical ventilation. Predictors included patient demographics, laboratory, respiratory, and physiologic variables, and medication use. RESULTS:The median time to death for the entire cohort was 0.58 hours (interquartile range (IQR) 0.22-2.25 hours) after withdrawal of mechanical ventilation. Using Cox regression, independent predictors of shorter time to death included higher positive end-expiratory pressure (per 1 cm H2O hazard ratio [HR], 1.07; 95% CI 1.04-1.11); higher static pressure (per 1 cm H2O HR, 1.03; 95% CI 1.01-1.04); extubation prior to death (HR, 1.41; 95% CI 1.06-1.86); and presence of diabetes (HR, 1.75; 95% CI 1.25-2.44). Higher noninvasive mean arterial pressure predicted longer time to death (per 1 mmHg HR, 0.98; 95% CI 0.97-0.99). CONCLUSIONS:Comorbid illness and key respiratory and physiologic parameters may inform physician predictions of time to death after withdrawal of mechanical ventilation. An understanding of the predictors of time to death may facilitate discussions with family members of dying patients and improve communication about end-of-life care.
journal_name
J Palliat Medjournal_title
Journal of palliative medicineauthors
Long AC,Muni S,Treece PD,Engelberg RA,Nielsen EL,Fitzpatrick AL,Curtis JRdoi
10.1089/jpm.2015.0115subject
Has Abstractpub_date
2015-12-01 00:00:00pages
1040-7issue
12eissn
1096-6218issn
1557-7740journal_volume
18pub_type
杂志文章abstract:BACKGROUND/AIM:Palliative care services (PCS) are recommended to enhance quality of care for hospitalized patients. METHODS:We evaluated the attitudes of liver transplant (LT) providers and perceived barriers to PCS for their patients by conducting a web-based survey of intensive care unit nurses, postgraduate year 1 ...
journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/jpm.2016.0002
更新日期:2016-08-01 00:00:00
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pub_type: 杂志文章,随机对照试验
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更新日期:2011-03-01 00:00:00
abstract:OBJECTIVE:The objective was to explore the utility of a new three-item depression screening tool concerning time and life perception (TLP-3), compared with the DSM-IV criteria. METHODS:This was a cross-sectional study of 63 Portuguese terminally ill patients, from May 2010 to November 2012. Patients were eligible if t...
journal_title:Journal of palliative medicine
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pub_type: 杂志文章
doi:10.1089/jpm.2013.0318
更新日期:2014-02-01 00:00:00
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pub_type: 杂志文章
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更新日期:2011-07-01 00:00:00
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pub_type: 杂志文章
doi:10.1089/jpm.2016.0086
更新日期:2016-06-01 00:00:00
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pub_type: 杂志文章,评审
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更新日期:2010-04-01 00:00:00
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pub_type: 杂志文章
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pub_type: 历史文章,杂志文章,评审
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更新日期:2019-12-01 00:00:00
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pub_type: 杂志文章
doi:10.1089/jpm.2020.0329
更新日期:2021-01-21 00:00:00
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pub_type: 杂志文章,评审
doi:10.1089/jpm.2014.0368
更新日期:2015-06-01 00:00:00
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journal_title:Journal of palliative medicine
pub_type: 杂志文章
doi:10.1089/10966210260499131
更新日期:2002-12-01 00:00:00
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doi:10.1089/jpm.2017.0097
更新日期:2018-02-01 00:00:00
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pub_type: 杂志文章
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更新日期:2014-01-01 00:00:00
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更新日期:2005-08-01 00:00:00
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更新日期:2001-10-01 00:00:00
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pub_type: 杂志文章,meta分析,评审
doi:10.1089/jpm.2017.0576
更新日期:2018-07-01 00:00:00
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pub_type: 杂志文章
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更新日期:2010-11-01 00:00:00
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更新日期:2011-06-01 00:00:00
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