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A Two-Group Trial of a Terminal Ventilator Withdrawal Algorithm: Pilot Testing.
Margaret L Campbell1, Hossein N Yarandi1, Michael Mendez2
11 College of Nursing, Wayne State University , Detroit, Michigan.
Journal of Palliative Medicine
|June 20, 2015
Summary
A nurse-led algorithm improved patient comfort during terminal ventilator withdrawal, reducing respiratory distress and stridor. This approach proved feasible for managing end-of-life care, enhancing patient experience.
Area of Science:
- Critical Care Medicine
- Nursing Practice
- Palliative Care
Background:
- Terminal ventilator withdrawal lacks empirical guidance, risking patient respiratory distress.
- Effective protocols are needed to ensure comfort during end-of-life mechanical ventilation cessation.
Purpose of the Study:
- To assess the feasibility of a nurse-led algorithm for terminal ventilator withdrawal.
- To compare patient comfort levels between algorithmic and usual care approaches.
- To evaluate differences in opioid and benzodiazepine use.
Main Methods:
- Prospective, two-group observational study in medical intensive care units (MICUs).
- Intervention group followed a nurse-led algorithm; control group received usual care.
- Respiratory Distress Observation Scale (RDOS) measured patient comfort.
Main Results:
- The nurse-led algorithm was feasible and successfully implemented.
- Fewer patients in the intervention group experienced post-extubation stridor (0% vs. 38%).
- Patients receiving algorithmic care reported significantly greater respiratory comfort (p<0.05).
Conclusions:
- A nurse-led algorithmic approach to terminal ventilator withdrawal is feasible.
- This algorithm demonstrates proof of concept for improving patient comfort and reducing distress.
- The study highlights the potential for standardized nursing interventions in end-of-life care.
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