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Withdrawal of Life Support in the Neurological Intensive Care Unit Neurol 52:1602-1609,1538, Mayer,S.A.&Kossoff,S.B., 1999 See this aricle in Pubmed Article Abstract Of 74 non-brain-dead patients, 32 (43%) were terminally extubated. Hispanic and white patients were more likely to be extubated than were African American patients (p = 0.02). The median duration survival after extubation was 7.5 hours; 25% died within 1 hour, and 69% within 24 hours. Depth of coma did not predict the duration of survival after extubation. The most frequent signs after extubation were agonal or labored breathing (59%) and tachypnea (34%). Morphine or fentanyl was given t o relieve respiratory distress in 68% of cases; the average dose of morphine was 6.3 mg/hour (range 2.5 to 20 mg/hour). In a structured interview of 24 surrogate decision-makers, 99% were satisfied or very satisfied with the overall process, and 75% felt the patient suffered minimally before death; all but one (96%) said that they would repeat the decision to withdraw life support. Forty-three percent of our non-brain-dead patients who died were terminally extubated. The duration of survival after ext ubation exceeded 24 hours in one third, and was not predicted by level of consciousness. Two thirds of patients were treated with opiods for agonal respiratory distress. Most surrogate decision-makers were comfortable and satisfied with the process of w ithdrawing care.

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(click to filter results - removes previous filter) critical care unit extubation,terminal life support,withdrawal of medical-legal aspects of neurology neurological intensive care palliative care practice guidelines respirator review article right to die

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