Eduardo Serra has just sent the article “Determinants of Receiving Palliative Care and Ventilator Withdrawal Among Patients With Prolonged Mechanical Ventilation” published in Critical Care Medicine. Until this article, no study has ever explored the willingness to receive palliative care or terminal withdrawal and the factors influencing willingness
As all of you know, patients receiving prolonged mechanical ventilation (PMV) typically experience long-term morbidity, suffering, poor quality of life, and high mortality.
The study was carried out in 5 hospitals in Taiwan in people who had more than 60 days with ventilatory support.
The family plays a key role in decision-making about palliative care and ventilator withdrawal because the majority of patients with PMV in the long-term care unit have poor consciousness level. The authors identified the families of 145 patients, recruiting 106. They collected information on the concept they had about palliative care (knowledge, attitude and experience); the caregiver’s burden; the role of the family; the quality of life and the medical-family communication.
The vast majority (90.4%) agreed with palliative care and 17.3% in the withdrawal of mechanical ventilation. A 67.5% agreed on the withdrawal of ventilation when the death outcome was evident, as well as the withdrawal of the other measures. More than half (56.7%) of the family members regretted having chosen prolonged mechanical ventilation.
Reduced patient quality of life and increased family understanding of palliative care significantly associated with increased caregiver willingness to endorse palliative care and withdraw life-sustaining agents in anticipation of death. Longer duration of ventilator usage and hospitalization was associated with increased feelings of regret about choosing prolonged mechanical ventilation.
The authors conclude that during prolonged mechanical ventilation, physicians should thoroughly discuss its benefits and burdens. Families should be given the opportunity to discuss the circumstances under which they might request the implementation of palliative care or withdrawal of mechanical ventilation in order to avoid prolonging the dying process.