Outcomes of Palliative Care Team Consultation for Ventilator Withdrawal from Terminally Ill Patients in the Intensive Care Unit

Background: The Hospice Palliative Care Act in Taiwan was amended and allowed families to withdraw life-sustaining treatment for unconsciousness terminally ill patients. However, ventilator withdrawal in the intensive care unit (ICU) is still a challenge. We designed this retrospective observational study to evaluate the outcomes of palliative care withdrawal from terminal patients in the ICU. Methods: We retrospectively collected data from patients who had consulted the palliative care team for ventilator withdrawal in the ICU. In a 2-year period, between 2013 and 2014, we reviewed the consultations in the surgical and medical ICU of a medical center. Results: There were 103 consultations for palliative care withdrawal in the ICU during 2013-2014. Thirty-seven patients who died within 72 hours after palliative care withdrawal were analyzed. The time to consult the palliative shared care team after admission to the ICU was significantly related to patients who had experienced the procedure of cardiopulmonary resuscitation. The time to death after ventilator withdrawal was significantly related to whether "do not resuscitate" had been written. Other factors were not significantly related to the survival time after ventilator removal. Conclusion: In our study, ventilator withdrawal is more acceptable for intensive-care physicians when cardiac arrest had happened previously, and late referral for palliative care is frequently in the ICU. The survival time after ventilator removal was not shorter for those with do not resuscitate status. For the purpose of better end-of-life care, the promotion of education for palliative care is necessary. Copyright (C) 2016, Taiwan Society of Geriatric Emergency & Critical Care Medicine. Published by Elsevier Taiwan LLC.