Practices in End of Life Care and in Discontinuing Mechanical Ventilation in Elderly Critically Ill Patients: A Nested Study within an International Observational Study
Results from this study will allow for comparing and contrasting of Canadian practices in discontinuing mechanical ventilation (breathing machines) and establishing goals of care in the elderly with those of intensive care units (ICUs) in other regions.
Findings: We expect that: (1) Rates of withholding (not starting) and withdrawing (stopping) life sustaining therapies to be higher in the very elderly (> 80 years) compared to the elderly (65 to 80 years) and will be established earlier in the ICU stay. We anticipate that rates of withholding and withdrawal of care will vary significantly across geographic regions. (2) Failed an attempt to wean from mechanical ventilation (or spontaneous breathing trial) in the very elderly will have greater adverse effects on clinical outcomes (e.g., duration of mechanical ventilation, ICU length of stay and mortality). (3) Non-invasive ventilation (NIV or mask ventilators) will be used more often in the very elderly compared to the elderly. Moreover, we expect to find significant variation in the use of NIV for palliation across geographic regions.
Impact of findings: Information obtained from this study will inform future discussions with patients and their family members regarding outcomes from mechanical ventilation and processes of care in the ICU. Information from this study is expected to help patients and family members be better informed in making decisions and decision makers to be better informants.
About the Project
Patients 65 years and older account for 26% to 51% of ICU admissions. Critically ill patients often rely on life support technologies such as mechanical ventilation to support them through an acute illness until their organs recover. With the aging middle sector of our population, the demand for mechanical ventilation is expected to increase in the near future.
Little research has been conducted to understand how mechanical ventilation is discontinued in elderly patients and how discussions regarding care at the end-of-life (EOL) evolve over the ICU stay.
For more details on the project rationale, objectives and research plan, click here.
Karen Burns, MD, MSc, FRCPC -- St. Michael's Hospital/University of Toronto
Deborah Cook, MD, MSc -- McMaster University
Peter Dodek, MD, MHSc -- St. Paul's Hospital
Maureen O. Meade, MD, MSc -- McMaster University
Project Contact: Leena Rizvi -- firstname.lastname@example.org
Key words: mechanical ventilation; weaning; end-of-life care; international; outcomes; decision-making