Compassionate Withdrawal of Mechanical Ventilation: Panel and Data Presentation Lawrence S' Hotes, M - PowerPoint PPT Presentation

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Compassionate Withdrawal of Mechanical Ventilation: Panel and Data Presentation Lawrence S' Hotes, M

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Retrospective chart review of all patients undergoing terminal withdrawal of MV ... Patient, family, clinical staff shared decision making. Resources ... – PowerPoint PPT presentation

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Title: Compassionate Withdrawal of Mechanical Ventilation: Panel and Data Presentation Lawrence S' Hotes, M


1
Compassionate Withdrawal of Mechanical
Ventilation Panel and Data PresentationLawrence
S. Hotes, MD, FACP, FACE Heidi OConnor, MD,
FCCP Brian Bloom, MD, MBA Gail Murphy, LICSW
Emily Appel, BSN, RN Suzanne Forti, RT
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Background
  • 20 patients requiring prolonged MV cant wean
  • 10 U.S. LTACH admits require prolonged MV
  • Usually transferred to an LTACH from either a
    med/surg ICU following an average acute LOS of 30
    days
  • Failure to wean from prolonged mechanical
    ventilation (MV) is common
  • Only 50 of patients admitted to an LTACH for
    weaning from prolonged MV eventually wean
  • Only 35 are successfully decannulated
  • Terminal wean process is not well described

4
Methods
  • We compared terminal withdrawal of MV at an LTACH
    with MICU
  • Retrospective chart review of all patients
    undergoing terminal withdrawal of MV in an LTACH
    (n30) and MICU (n74) over a 2-year period

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10
Limitations
  • Chart review
  • LTACH patients identified prospectively, MICU
    patients identified retrospectively
  • May have underestimated number of MICU patients
    undergoing terminal withdrawal of MV
  • Chart abstractors could not be blinded to the
    hospital but were blinded to study hypothesis

11
Conclusions
  • Terminal withdrawal of MV in the LTACH differs
    from that in the MICU
  • Time elapsed weeks vs days
  • Patient involvement
  • Decision making
  • Benzodiazepine use
  • Cause of death

12
Future Directions
  • Improved communication about prolonged MV
  • Patient, family, clinical staff shared decision
    making
  • Resources
  • Social work, psychiatry, pastoral care
  • Medications
  • Guidelines

13
Case Discussion
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