Ventilator Withdrawal Guidelines - Massachusetts General Hospital and Harvard Medical School

Name:
Massachusetts General Hospital, Medical ICU Project: Ventilator Withdrawal Guidelines

Description:
Guidelines for preparation of family and clinical team for vent withdrawal, including care of family during procedure.

Category:
Educational - Clinician Education

Source:
Massachusetts General Hospital
Palliative Care Services
55 Fruit Street
Boston MA 02114
www.massgeneral.org

Contact:
J. Andrew Billings, M.D.
jbillings@partners.org

How the grantee used this instrument:
Concise guidelines take the clinician through preparation of family and clinical team members for vent withdrawal, suggested regimens for sedation/analgesic dosing, setting the scene for vent withdrawal with family and staff, and special notes on how to talk with the family about withdrawal.

Keywords:
inpatient, care coordination, care plan, care planning, protocols, emotional well-being, decision-making, anticipatory grief, bereavement care, social work, clergy, clinical information, communication

To use this tool:
You may download and use this tool from this site. Please credit the source.

References:

  • Brody H, Campbell ML, Faber-Langendoen K, Ogle KS. Withdrawing intensive life-sustaining treatment -- recommendations for compassionate clinical management. N Engl J Med 1997;336: 652-7
  • Campbell ML. Terminal dyspnea and respiratory distress. Crit Care Clin. 2004; 20:403-17. Curtis JR, Rubenfeld GD, eds. Managing Death in the Intensive Care Unit: The Transition from Cure to Comfort. New York, Oxford University Press, 2001.
  • Hawryluck LA, Harvey WRC, Lemieux-Charles L, Singer PA. Consensus guidelines on analgesia and sedation in dying intensive care unit patients. BMC Medical Ethics 2002;3:3. www.biomedcentral.com/1472-6939/3/3
  • O'Mahoney S, McHugh M, Zallman L, Selwyn P. Ventilator withdrawal: procedures and outcomes. Report of a collaboration between a critical care division and a palliative care service. J Pain Symptom Manage 2003; 26: 954-961.
  • Prendergast TJ, Puntillo KA. Withdrawal of life support: intensive caring at the end of life. JAMA 2002:288:2732-2740.
  • Truog RD, Cist AFM, Brackett SE, Burns JP, Curley MAQ, Danis M, DeVita MA, Rosenbaum SH, Rothenberg DM, Sprung CL, Webb SA, Wlody GS, Hurford WE. Recommendations for end-of-life care in the intensive care unit: The Ethics Committee of the Society of Critical Care Medicine. Crit Care Med 2001;29:2332-2348.
  • Treece PD, Engelberg RA, Crowley L, Chan JD, Rubenfeld GD, Steinberg KP, Curtis, JR. Evaluation of a standardized order form for the withdrawal of life support in the intensive care unit. Crit Care Med 2004; 32:1141-1148.
  • Way J, Back AL, Curtis JR. Withdrawing life support and resolution of conflict with families. BMJ 2003; 325:1342-1345.
Reference to ventilator withdrawal policies:
  • Massachusetts General Hospital Policy and Procedures: Limitation of Life Sustaining Treatment Policy.
  • Harborview Medical Center-University of Washington Medical Center, Seattle, Washington, "Comfort Care Orders for the Withdrawal of Life Support in the ICU."
  • The Johns Hopkins Hospital, Policy: "Procedure for Withdrawal of Life Support in the MICU/MCP."
  • Hospice and Palliative Care of Metropolitan Washington Protocol: "Discontinuing of Ventilator Support." 2001.
To view this tool:

Ventilator Withdrawal Guidelines - 6 page PDF
(Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)

Posted: July 2006

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Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying people and their families.