Procedures used in withdrawal of mechanical ventilation

OBJECTIVE: The purpose of this study was to describe ways in which withdrawal of mechanical ventilation is carried out in one institution, patient responses to the various methods of withdrawal, and nurses' perceptions of the methods and morality of ventilator withdrawal. METHOD: A retrospective descriptive study was used with a convenience sample of adult patients who underwent terminal weaning at University Hospitals of Cleveland. Demographic and clinical data, and descriptions of the exact method of ventilator withdrawal were collected from the medical records of these patients. The nurse caring for the patient was interviewed about his or her perceptions, within 7 days of the withdrawal. RESULTS: Data were obtained on 42 subjects. There were no differences in mental status, ventilatory status, age, or duration of survival between the patients who had support removed gradually and those from whom it was abruptly removed. Morphine was administered to 88% of the sample during withdrawal. Survival duration was unrelated to morphine dosage, but did correlate with ventilatory status at the time of withdrawal. Every nurse interviewed reported that he or she believed the act of withdrawal for that patient was morally correct, although only 85% were completely comfortable with carrying out the procedure. CONCLUSIONS: These results provide a foundation for preliminary recommendations about the most humane form of ventilator withdrawal and the appropriate use of narcotics and sedatives during withdrawal.