Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study - Université de Lille
Article Dans Une Revue Intensive Care Medicine Année : 2020

Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study

1 UP - Université de Poitiers = University of Poitiers
2 CIC 1402 - CIC Poitiers – Centre d'investigation clinique de Poitiers
3 CHU de Poitiers [La Milétrie] - Centre hospitalier universitaire de Poitiers = Poitiers University Hospital
4 CHU Trousseau [Tours]
5 CIC - Centre d’Investigation Clinique [Tours] CIC 1415
6 AP-HP - Hopital Saint-Louis [AP-HP]
7 DRIS - Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM]
8 Service de Réanimation polyvalente [Chartres]
9 CHRO - Centre Hospitalier Régional d'Orléans
10 Hôpital Cochin [AP-HP]
11 UPCité - Université Paris Cité
12 TIMONE - Hôpital de la Timone [CHU - APHM]
13 Service de Réanimation Médicale [CHU Bordeaux]
14 UB - Université de Bordeaux
15 Hôpital Foch [Suresnes]
16 GHBS - Groupe Hospitalier Bretagne Sud
17 Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
18 Université de Lille
19 RTD - Recherche translationnelle sur le diabète - U 1190
20 UA - Université d'Angers
21 CHU Angers - Centre Hospitalier Universitaire d'Angers
22 Hôpitaux La Rochelle Ré Aunis [Groupe hospitalier littoral Atlantique]
23 CRICS (EA_3965) - Centre de recherche sur l'interculturalité et la circulation médiatique des savoirs
24 Hôpital Bretonneau
25 UT - Université de Tours
26 IAME (UMR_S_1137 / U1137) - Infection, Anti-microbiens, Modélisation, Evolution
27 UBO UFR MSS - Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé
28 CHU - BREST - Hôpital de la Cavale Blanche - CHRU Brest
29 CHD Vendée - Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon
30 CHU Nantes - Centre Hospitalier Universitaire de Nantes = Nantes University Hospital
31 Nantes Univ - UFR MEDECINE - Nantes Université - UFR de Médecine et des Techniques Médicales

Résumé

Purpose: Little is known on the incidence of discomfort during the end-of-life of intensive care unit (ICU) patients and the impact of sedation on such discomfort. The aim of this study was to assess the incidence of discomfort events according to levels of sedation.
Methods: Post-hoc analysis of an observational prospective multicenter study comparing immediate extubation vs. terminal weaning for end-of-life in ICU patients. Discomforts including gasps, significant bronchial obstruction or high behavioural pain scale score, were prospectively assessed by nurses from mechanical ventilation withdrawal until death. Level of sedation was assessed using the Richmond Agitation–Sedation Scale (RASS) and deep sedation was considered for a RASS − 5. Psychological disorders in family members were assessed up until 12 months after the death.
Results: Among the 450 patients included in the original study, 226 (50%) experienced discomfort after mechanical ventilation withdrawal. Patients with discomfort received lower doses of midazolam and equivalent morphine, and were less likely to have deep sedation than patients without discomfort (59% vs. 79%, p < 0.001). After multivariate logistic regression, extubation (as compared terminal weaning) was the only factor associated with discomfort, whereas deep sedation and administration of vasoactive drugs were two factors independently associated with no discomfort. Long-term evaluation of psychological disorders in family members of dead patients did not differ between those with discomfort and the others.
Conclusion: Discomfort was frequent during end-of-life of ICU patients and was mainly associated with extubation and less profound sedation.
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Dates et versions

hal-04696858 , version 1 (13-09-2024)

Identifiants

Citer

Rene Robert, Amélie Le Gouge, Nancy Kentish-Barnes, Mélanie Adda, Juliette Audibert, et al.. Sedation practice and discomfort during withdrawal of mechanical ventilation in critically ill patients at end-of-life: a post-hoc analysis of a multicenter study. Intensive Care Medicine, 2020, Intensive Care Medicine, 46, pp.1194-1203. ⟨10.1007/s00134-020-05930-w⟩. ⟨hal-04696858⟩
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