The Durban World Congress Ethics Round Table Conference Report: III. Withdrawing Mechanical ventilation--the approach should be individualized

Fathima Paruk; Niranjan Kissoon; Christiane S Hartog; Charles Feldman; Eric R Hodgson; Jeffrey Lipman; Bertrand Guidet; Bin Du; Andrew Argent; Charles L Sprung

doi:10.1016/j.jcrc.2014.05.022

The Durban World Congress Ethics Round Table Conference Report: III. Withdrawing Mechanical ventilation--the approach should be individualized

J Crit Care. 2014 Dec;29(6):902-7. doi: 10.1016/j.jcrc.2014.05.022. Epub 2014 Jun 4.

Authors

Affiliations

¹ Department of Anaesthesiology and Division of Critical Care, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. Electronic address: Fathima.Paruk@wits.ac.za.
² Department of Pediatrics and Emergency Medicine, Children's Hospital and Sunny Hill Health Centre for Children, University of British Columbia, Vancouver, British Columbia, Canada.
³ Department of Anesthesiology and Intensive Care Medicine and Center for Sepsis Control and Care (CSH), Jena University Hospital, Jena, Germany.
⁴ Division of Pulmonology, Department of Internal Medicine, Charlotte Maxeke Johannesburg Academic Hospital and Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
⁵ Department of Anaesthesia and Critical Care, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal eThekwini-Durban, KwaZulu-Natal, South Africa.
⁶ Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and The University of Queensland, Queensland, Australia.
⁷ Service de Réanimation Médicale, Assistance Publique-Hôpitaux de Paris, Hôpital St-Antoine, Paris, France.
⁸ Medical Intensive Care Unit, Peking Union Medical College Hospital, Beijing, China.
⁹ School of Child and Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
¹⁰ Department of Anesthesiology and Critical Care Medicine (CLS), Hadassah Hebrew University Medical Center, Jerusalem, Israel.

PMID: 24992878
DOI: 10.1016/j.jcrc.2014.05.022

Abstract

Purpose: The purpose of this study is to determine the approaches used in withdrawing mechanical ventilator support.

Materials and methods: Speakers from the invited faculty of the World Federation of Societies of Intensive and Critical Care Medicine Congress in 2013 with an interest in ethics were asked to provide a detailed description of individual approaches to the process of withdrawal of mechanical ventilation.

Results: Twenty-one participants originating from 13 countries, responded to the questionnaire. Four respondents indicated that they do not practice withdrawal of mechanical ventilation, and another 4 indicated that their approach is highly variable depending on the clinical scenario. Immediate withdrawal of ventilation was practiced by a large number of the respondents (7/16; 44%). A terminal wean was practiced by just more than a third of the respondents (6/16; 38%). Extubation was practiced in more than 70% of instances among most of the respondents (9/17; 53%). Two of the respondents (2/17; 12%) indicated that they would extubate all patients, whereas 14 respondents indicated that they would not extubate all their patients. The emphasis was on tailoring the approach used to suit individual case scenarios.

Conclusions: Withdrawing of ventilator support is not universal. However, even when withdrawing mechanical ventilation is acceptable, the approach to achieve this end point is highly variable and individualized.

Keywords: Ethics; Life-sustaining treatments; Mechanical ventilation; Withdrawing; Withholding.

MeSH terms

Congresses as Topic
Critical Care / statistics & numerical data*
Humans
Respiration, Artificial / statistics & numerical data*
South Africa
Surveys and Questionnaires
Ventilator Weaning / statistics & numerical data
Withholding Treatment / statistics & numerical data*