Background: Vent withdrawal (VW) is a procedure offered when an intubated patient fails to demonstrate meaningful recovery, the patient is not likely to survive given the extent or burden of underlying medical conditions, or patient’s best anticipated outcome from ongoing ventilator support is inconsistent with patient’s known or presumed wishes. Comfort of the patient after VW is ensured with medications to relieve pain indicated by symptomatic signs of distress, including excessive use of accessory muscles of respiration, excessive oral secretions and convulsions. The health care proxy or surrogate decision maker, as well as those family and friends who wish to remain at the bedside during the VW process, are informed prior to withdrawal what they can expect, however it still remains difficult to provide accurate estimations regarding expected length of survival following VW. We aim to investigate if length of survival following VW is influenced by clinical criteria, in particular, whether the primary indication for incubation was due to an underlying pulmonary cause.
Methods: Retrospective chart review of adult patients who underwent VW at our institution, between January 2012 to January 2017, Patient demographics, indication for intubation, primary diagnosis, comorbidities, medications to control pain symptoms, timing of palliative care involvement, usage and types of life sustaining measures and the effects of these variables to the outcomes including length of survival, disposition for the patients who survived until discharge were reviewed. This study was reviewed and approved by the IRB.
Results: The medical records of 79 patients that met inclusion criteria were reviewed. Of those patients, 76% (N=60) proceeded to pass away following VW, with 18% (N=14) surviving to placement in inpatient hospice and 5% (N=4) returning home. Patients who passed away on the day of VW survived an average of 2 hours and 23 minutes, with a range of 8 minutes to 8 hours and 53 minutes. For those who survived past the first day of VW, the average length of survival was 4.2 days for all intubation indications. However when this sample was further stratified according to intubation indications, patients who were intubated for pulmonary indications survived 2.7 days, while the non-pulmonary indication group survived for 4.78 days.
Conclusions: The data indicates that the shorter survival time in patients intubated for pulmonary causes however further studies of larger patient sets will be required before we can adjust our recommendations to reflect these findings. Nevertheless, the information presented here adds to the growing body of knowledge regarding the outcome metrics of VW.