Mechanical ventilation withdrawal in motor neuron disease: an evaluation of practice.
chronic conditions
drug administration
end of life care
ethics
neurological conditions
Journal
BMJ supportive & palliative care
ISSN: 2045-4368
Titre abrégé: BMJ Support Palliat Care
Pays: England
ID NLM: 101565123
Informations de publication
Date de publication:
Dec 2022
Dec 2022
Historique:
received:
18
12
2019
revised:
13
03
2020
accepted:
19
04
2020
pubmed:
23
5
2020
medline:
30
11
2022
entrez:
23
5
2020
Statut:
ppublish
Résumé
Clinicians report that withdrawal of mechanical ventilation in motor neuron disease is challenging. We report on the evaluation of the process and outcomes called for by the Association for Palliative Medicine of Great Britain and Ireland (APM) guidance. Excel analysis of a core data set, defined in the APM guidance, and thematic analysis of free-text comments, submitted by a UK clinician soon after withdrawal of mechanical ventilation in any care setting. Thirty-seven professionals submitted 46 data sets from 4 patients with tracheostomy ventilation (TV) and 42 with non-invasive ventilation (NIV) in 35 months. These took place at home (43%), inpatient hospice (48%), hospital and care homes. Eighty-nine per cent received opioid and/or sedative medication at the initiation of withdrawal, majority of which were subcutaneous. A median of 2 doses (range 1-9) were used to manage symptoms before ventilation withdrawal. Subsequently 73% of patients required either none or one dose of medication. In addition to any background opioid, symptom management required a total parenteral morphine equivalent mean of 20.6 mg (range 0-60 mg) and midazolam mean of 25.8 mg (range 0-120 mg). The median time from first medication to removal of mechanical ventilation was 45 min. Patients with TV died within 30 min of withdrawal. The mode (14 of 42 patients) time to death after NIV withdrawal was 15 min, but ranged between <15 min and 54 hours. Individualised, proportionate, titrated opioid and sedative medications were used to provide good symptom management, and provided new insight into the substantial variability in what patients require to manage their symptoms and how long the process takes. Most patients required lower doses than in previous literature.
Identifiants
pubmed: 32439630
pii: bmjspcare-2019-002170
doi: 10.1136/bmjspcare-2019-002170
pmc: PMC9726956
doi:
Substances chimiques
Analgesics, Opioid
0
Hypnotics and Sedatives
0
Midazolam
R60L0SM5BC
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e752-e758Informations de copyright
© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: CF has received other competitive grant funding from the Motor Neurone Disease Association.
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