Title :

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

Author(s) :

Robert, Rene [Auteur]
Université de Poitiers = University of Poitiers [UP]
CIC Poitiers – Centre d'investigation clinique de Poitiers [CIC 1402]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Le Gouge, Amélie [Auteur]
CHU Trousseau [Tours]
Centre d’Investigation Clinique [Tours] CIC 1415 [CIC ]
Kentish-Barnes, Nancy [Auteur]
Hopital Saint-Louis [AP-HP] [AP-HP]
Adda, Mélanie [Auteur]
Service de réanimation-Détresses Respiratoires et Infections Sévères [Hôpital Nord - APHM] [DRIS]
Audibert, Juliette [Auteur]
Service de Réanimation polyvalente [Chartres]
Barbier, François [Auteur]
Centre Hospitalier Régional d'Orléans [CHRO]
Bourcier, Simon [Auteur]
Hôpital Cochin [AP-HP]
Université Paris Cité [UPCité]
Bourenne, Jeremy [Auteur]
Hôpital de la Timone [CHU - APHM] [TIMONE]
Boyer, Alexandre [Auteur]
Service de Réanimation Médicale [CHU Bordeaux]
Université de Bordeaux [UB]
Devaquet, Jérôme [Auteur]
Hôpital Foch [Suresnes]
Grillet, Guillaume [Auteur]
Groupe Hospitalier Bretagne Sud [GHBS]
Guisset, Olivier [Auteur]
Service de Réanimation Médicale [CHU Bordeaux]
Université de Bordeaux [UB]
Hyacinthe, Anne-Claire [Auteur]
Centre Hospitalier Annecy-Genevois [Saint-Julien-en-Genevois]
Jourdain, Mercedes [Auteur]
Université de Lille
Recherche translationnelle sur le diabète (RTD) - U1190
Lerolle, Nicolas [Auteur]
Université d'Angers [UA]
Centre Hospitalier Universitaire d'Angers [CHU Angers]
Lesieur, Olivier [Auteur]
Groupe hospitalier de La Rochelle
Mercier, Emmanuelle [Auteur]
Centre de recherche sur l'interculturalité et la circulation médiatique des savoirs [CRICS (EA_3965)]
Hôpital Bretonneau
Université de Tours [UT]
Messika, Jonathan [Auteur]
Infection, Anti-microbiens, Modélisation, Evolution [IAME (UMR_S_1137 / U1137)]
Renault, Anne [Auteur]
Université de Bretagne Occidentale - UFR Médecine et Sciences de la Santé [UBO UFR MSS]
Hôpital de la Cavale Blanche - CHRU Brest [CHU - BREST ]
Vinatier, Isabelle [Auteur]
Centre Hospitalier Départemental - Hôpital de La Roche-sur-Yon [CHD Vendée]
Azoulay, Elie [Auteur]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Thille, Arnaud W. [Auteur]
Université de Poitiers = University of Poitiers [UP]
CIC Poitiers – Centre d'investigation clinique de Poitiers [CIC 1402]
Centre hospitalier universitaire de Poitiers = Poitiers University Hospital [CHU de Poitiers [La Milétrie]]
Reignier, Jean [Auteur]
Centre Hospitalier Universitaire de Nantes = Nantes University Hospital [CHU Nantes]
Nantes Université - UFR de Médecine et des Techniques Médicales [Nantes Univ - UFR MEDECINE]

Journal title :

Intensive Care Medicine

Abbreviated title :

Intensive Care Med

Volume number :

46

Pages :

1194–1203

Publisher :

Springer Verlag

Publication date :

2020-01-29

ISSN :

1432-1238

English keyword(s) :

End-of-life
Sedation
Discomfort
Withdrawal mechanical ventilation

HAL domain(s) :

Sciences du Vivant [q-bio]

English abstract : [en]

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 ...
Show more >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.Show less >

Language :

Anglais

Audience :

Internationale

Popular science :

Non

Administrative institution(s) :

Université de Lille
Inserm
CHU Lille

Collections :

• Recherche translationnelle sur le diabète (RTD) - U1190

Submission date :

2024-01-19T23:35:26Z
2024-09-13T11:32:55Z