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Factors associated with physicians’ decisions to withdraw mechanical ventilation in anticipation of death
  1. A R L Medford
  1. Clinical Research Fellow and Honorary Specialist Registrar, University of Bristol, Southmead Hospital, Bristol, UK

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Eight hundred and fifty one consecutive patients mechanically ventilated for at least 72 hours in intensive care units in 15 different centres were prospectively followed. The relation between various factors and withdrawal of mechanical ventilation was assessed using Cox proportional hazards analysis.

Ventilation was withdrawn in 19.5% of the original cohort. Four factors were identified as being associated with withdrawal of ventilation: use of inotropes and vasopressors (hazard ratio 1.78, p = 0.004), physician’s prediction of a less than 10% chance of survival (hazard ratio 3.49, p = 0.002) and of severely impaired future cognitive function (hazard ratio 2.51, p = 0.04), and the physician’s perception that the patient did not want life support (hazard ratio 4.19, p<0.001).

Physicians’ perceptions and predictions formed the majority of factors in this study, which extends our understanding of the process of withdrawal of life support and questions the traditional biomedical model used (age and severity of illness or organ dysfunction were not factors). It is encouraging that one of the key factors was the wishes of the patients, but these might not be accurately reflected by relatives or physicians. Further research is required to clarify this issue.

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