Terminal weaning in critically ill patients

Introduction

The withdrawal of mechanical ventilation as a terminal care process occurs with increasing frequency. The aim of the study was to analyze patients undergoing terminal weaning (TW) at ICU in tertiary care hospital during period 1999-2001.

Methods

A prospective, descriptive study of all patients experienced TW during a 3 years period was conducted. Diagnosis, length of ICU stay (LOS) in days before decision of TW was made, length of TW (LTW) in minutes, way of TW (SW = step-wise reduction or VW = ventilator withdrawal), providing information about TW to the family, adequacy of documentation and difference in LTW between selected patients subgroups were also evaluated. Data as mean ± SD (minimum-maximum) or median (25-75%), t-test or Mann-Whitney Rank Sum Test were used, P < 0.05 was considered statistically significant.

Results

Thirty-nine patients were studied, age 52 ± 22 years, LOS 8.7 ± 14 (0.2-84) days, LTW 196 ± 344 (3-1634) min. The TW procedure was step-wise reduction of ventilatory support (SW) in 18 patients and ventilator withdrawal (VW) in 21 patients. There was significant difference in LTW between patients with SW compared to patients with VW (20, 13-58 min resp. 82, 20-597, P = 0.04). There were 26 patients with primary brain damage (group BD) and 13 patients without primary brain damage (group NBD). Selected results are presented:

Discussion

LOS before decision of TW was significantly longer in patients without brain damage. The LTW did not differ significantly between patients with or without brain damage, however LTW was shorter in patients undergoing ventilator withdrawal compared to step-wise reduction of ventilatory support.

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