[Withdrawing respiratory support in patients in intensive care]

End of life decisions have been considered as an important part of making decisions in terminally critically ill patients. Withdrawing mechanical ventilation (terminal weaning) represents one of the procedures limiting life support therapy. The aim of the study was to examine the clinical experiences of limiting ventilatory support at tertiary care hospital ICU in Czech Republic.

A retrospective, descriptive study of all patients experienced terminal weaning (TW) in years 1999-2001 was conducted. Diagnosis, length of ICU stay (LOS) in days before decision of TW was made, duration of TW (TW time = time from starting TW to cardiac arrest in minutes), way of TW and difference in TW time between selected patients subgroups were also evaluated. Selected data are presented as mean or median, t-test or Mann-Whitney Rank Sum Test were used, p < 0.05 was considered statistically significant. The TW procedure was employed in 46 patients, stepwise reduction of ventilatory support was performed in 23 patients, ventilator withdrawal procedure in 23 patients. The mean TW time in all patients was 188 minutes. There was shorter TW time in patients with analgosedation comparing to those without (median 17, resp. 161 minutes, p = 0.002). Patients without respiratory activity showed shorter TW time comparing to patients with preserved respiratory activity (median 17, resp. 85 minutes, p = 0.014).

Terminal weaning represents an important part of processes of discontinuing life-sustaining therapies in terminally critically ill patients. There is medical, ethical and legal basis to employ this procedure at intensive care unit.