Medicina pulmonar y respiratoria

Palliative Care Consultation to Assist Discussion of Ventilator Withdrawal in a Medical Center in Taiwan

Abstract

Wei-Hsin Chiu, Wu-Chou Su, Jui-Hung Tsai, Wei-Pang Chung, Kai-Ling Jan, Han-Yu Chang and Ming-Liang Lai

Objective: The decision to withdraw ventilator support for terminal patients is difficult for health professionals and patients’ surrogates. Some intensive care unit physicians attempt to discuss the issue with surrogates. This retrospective study aimed to explore current dilemmas of ventilator withdrawal.

Methods: This is a retrospective review and analysis of medical records of terminal patients receiving ventilator support. The medical records of thirty-eight terminal patients who had received palliative care consultation for ventilator withdrawal at the National Cheng Kung University Hospital from August 2007 to January 2014 were reviewed retrospectively. Patients’ characteristics, including age, gender, diagnosis, withdrawal medications for symptom relief, and period from withdrawal to death, were analyzed.

Results: Thirteen patients were withdrawn from ventilator support and seven were weaned successfully. Eight surrogates signed consents for ventilator withdrawal, but patients died before withdrawal. Patients median age at withdrawal was 75 years (range: 53~80 years), and 46% had terminal cancer. The median period from withdrawal to death was 1.17 hours (range: 0.1~80.92 hours). Withdrawal was performed by palliative care physicians (23%), and 77% of withdrawal was performed in the intensive care unit.

Conclusion: Family conference, good symptom control and psychosocial support are necessary for surrogates’ ventilator withdrawal decisions. Encouraging more health care professionals to establish shared decision-making relationships could reduce the application of futile medical treatment.