Incidence and Risk Model Development for Severe Tachypnea Following Terminal Extubation

Area of Science:

• Critical Care Medicine
• Respiratory Physiology
• Palliative Care

Background:

• Palliative ventilator withdrawal (PVW) is a frequent intervention in intensive care units (ICUs).
• Assessing and managing patient symptoms during PVW is crucial for end-of-life care.

Purpose of the Study:

• To quantify the incidence of severe tachypnea as a surrogate for dyspnea following PVW.
• To identify patient and treatment characteristics associated with severe tachypnea post-PVW.

Main Methods:

• Retrospective cohort study of 822 ICU patients undergoing PVW between 2008 and 2012.
• Primary outcome: at least one episode of severe tachypnea (respiratory rate > 30 breaths/min) within 6 hours post-PVW.
• Multivariable logistic regression analyzed associations between patient/treatment factors and tachypnea.

Main Results:

• 30% of patients experienced severe tachypnea within 6 hours of PVW.
• Factors associated with increased tachypnea included: no pre-extubation opiates (aOR 2.08), lung injury (aOR 3.33), GCS > 8 (aOR 2.21), and no postextubation opiates (aOR 1.90).

Conclusions:

• Severe tachypnea is a common complication after PVW in the ICU.
• Proactive administration of pre-extubation opiates is a significant modifiable factor to mitigate tachypnea and improve symptom control.