Terminal weaning from mechanical ventilation: planning and process

There are two major goals of critical care: (1) to save those with a chance to live and (2) to help patients who are dying have a peaceful and dignified death. If reversal of the disease process is not possible and the patient is experiencing substantial pain and suffering, goals need to be reviewed and potentially redefined. These new goals may be to remove unwanted or nonbeneficial therapy, to provide death with dignity, and to support the family. This article details aspects of the decision-making process regarding withdrawal of mechanical ventilation, including ethical principles; decision-making for autonomous patients and non-autonomous patients; advance directives; planning withdrawal of support; terminal weaning methods; patient comfort; family support; and future directions for research, practice, and education.