Ventilator Withdrawal Guidelines - Massachusetts General Hospital and Harvard Medical
Massachusetts General Hospital, Medical ICU Project: Ventilator Withdrawal Guidelines
Guidelines for preparation of family and clinical team for vent withdrawal, including
care of family during procedure.
Educational - Clinician Education
Massachusetts General Hospital
Palliative Care Services
55 Fruit Street
Boston MA 02114
J. Andrew Billings, M.D.
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.
inpatient, care coordination, care plan, care planning, protocols, emotional well-being,
decision-making, anticipatory grief, bereavement care, social work, clergy, clinical
To use this tool:
You may download and use this tool from this site. Please credit the source.
Reference to ventilator withdrawal policies:
- Brody H, Campbell ML, Faber-Langendoen K, Ogle KS. Withdrawing intensive life-sustaining
treatment -- recommendations for compassionate clinical management. N Engl J Med
- 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
- 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.
- Massachusetts General Hospital Policy and Procedures: Limitation of Life Sustaining
- 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
- 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.