Department of Hematology-Oncology, Chang Gung Memorial Hospital at Linkou, Taiwan.
Department of Nursing, Chang Gung Medical Foundation at Linkou, Taiwan.
J Formos Med Assoc. 2018 Sep;117(9):798-805. doi: 10.1016/j.jfma.2017.09.014. Epub 2017 Oct 12.
Withdrawal of mechanical ventilation is an important, but rarely explored issue in Asia during end-of-life care. This study aimed to describe the clinical characteristics and survival outcomes of terminally ill patients undergoing withdrawal of mechanical ventilation in Taiwan.
One-hundred-thirty-five terminally ill patients who had mechanical ventilation withdrawn between 2013 and 2016, from a medical center in Taiwan, were enrolled. Patients' clinical characteristics and survival outcomes after withdrawal of mechanical ventilation were analyzed.
The three most common diagnoses were organic brain lesion, advanced cancer, and newborn sequelae. The initiator of the withdrawal process was family, medical personnel, and patient him/herself. The median survival time was 45 min (95% confidence interval, 33-57 min) after the withdrawal of mechanical ventilation, and 102 patients (75.6%) died within one day after extubation. The median time from diagnosis of disease to receiving life-sustaining treatment and artificial ventilation support, receiving life-sustaining treatment and artificial ventilation support to "Withdrawal meeting," "Withdrawal meeting" to ventilator withdrawn, and ventilator withdrawn to death was 12.1 months, 19 days, 1 day, and 0 days, respectively. Patients with a diagnosis of advanced cancer and withdrawal initiation by the patients themselves had a significantly shorter time interval between receiving life-sustaining treatment and artificial ventilation support to "Withdrawal meeting" compared to those with non-cancer diseases and withdrawal initiation by family or medical personnel.
This study is the first observational study to describe the patients' characteristics and elaborate on the survival outcome of withdrawal of mechanical ventilation in patients who are terminally ill in an Asian population. Understanding the clinical characteristics and survival outcomes of mechanical ventilation withdrawal might help medical personnel provide appropriate end-of-life care and help patients/families decide about the withdrawal process earlier.
在亚洲，生命末期的患者停止使用机械通气是一个重要但很少被探讨的问题。本研究旨在描述台湾地区终末期患者停止使用机械通气的临床特征和生存结局。
本研究纳入了 2013 年至 2016 年间，台湾一家医学中心的 135 例接受机械通气停止的终末期患者。分析了患者停止机械通气后的临床特征和生存结局。
最常见的三种诊断为器质性脑损伤、晚期癌症和新生儿后遗症。停止机械通气的启动者为家属、医务人员和患者本人。停止机械通气后中位生存时间为 45 分钟（95%置信区间，33-57 分钟），102 例（75.6%）患者在拔管后 1 天内死亡。从诊断疾病到接受生命支持治疗和人工通气支持、接受生命支持治疗和人工通气支持到“停止通气会议”、“停止通气会议”到呼吸机撤离，以及呼吸机撤离到死亡的中位时间分别为 12.1 个月、19 天、1 天和 0 天。与非癌症疾病和由家属或医务人员启动停止通气相比，诊断为晚期癌症和由患者本人启动停止通气的患者，从接受生命支持治疗和人工通气支持到“停止通气会议”的时间间隔明显缩短。
本研究是第一份观察性研究，描述了亚洲人群中终末期患者停止机械通气的患者特征和生存结局。了解机械通气停止的临床特征和生存结局可能有助于医务人员提供适当的临终关怀，并帮助患者/家属更早地决定停止通气过程。
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