The following is a summary of “Evidence Guiding Withdrawal of Mechanical Ventilation at the End of Life: A Review,” published in the September 2023 issue of Pain and Symptom Management by Mazzu, et al.

End-of-life distress is widespread in the intensive care unit (ICU). Evidence-based guidelines for assessing and managing symptoms in adults, and especially the elderly, toward the end of life in the intensive care unit (ICU) were reviewed. A methodical search of PubMed, Embase, and Web of Science for articles published on WMV at the end of life in the ICU environment among adults (January 1990-December 2021). Methods were reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. The WMV patients in the intensive care unit are all adults (over the age of 18).

GRADE stands for “Grading of Recommendations Assessment, Development, and Evaluation,” and it was used to determine how well studies performed. Only 130 of the 574 articles that passed the initial screening were read in their entirety, and of those, 74 were evaluated for quality. Validated symptom scales were the subject of the best-quality studies on WMV. In general, the quality of research into the WMV process was lower. Structured communication and social support are most helpful to the ICU staff.

Although there is strong evidence supporting the use of opiates for dyspnea, there is not enough information to guide the implementation of their usage for individual patients. Some palliative WMV methods have been shown to be effective by high-quality studies, whereas there is less evidence for others, such as the WMV process, helping the ICU staff, and medically managing suffering. To lessen suffering towards the end of life, future research should compare WMV processes and symptom management rigorously.

Source: sciencedirect.com/science/article/abs/pii/S0885392423005171