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Original Research: CRITICAL CARE MEDICINE |

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Colin R. Cooke, MD; David L. Hotchkin, MD; Ruth A. Engelberg, PhD; Lewis Rubinson, MD, PhD, FCCP; J. Randall Curtis, MD, FCCP
Author and Funding Information

From the Division of Pulmonary and Critical Care Medicine (Dr Cooke) and Robert Wood Johnson Foundation Clinical Scholars Program (Dr Cooke), University of Michigan, Ann Arbor, MI; Division of Pulmonary, Critical Care and Sleep Medicine (Dr Hotchkin), The Oregon Clinic, Portland, OR; Division of Pulmonary and Critical Care Medicine (Drs Engelberg, Rubinson, and Curtis), University of Washington, Seattle, WA; and Emergency Care Coordination Center (Dr Rubinson), Office of Assistant Secretary for Preparedness and Response, Department of Health and Human Services, Washington, DC.

Correspondence to: Colin R. Cooke, MD, Division of Pulmonary and Critical Care Medicine, University of Michigan, 6312 Medical Sciences Bldg I, 1150 W Medical Center Dr, Ann Arbor, MI, 48109-5604; e-mail: cookecr@umich.edu


Funding Support: This work was supported by the National Institute of Nursing Research [RO1NR05226], a grant from the Robert Wood Johnson Foundation (to Dr Curtis), and the Robert Wood Johnson Foundation Clinical Scholars Program (to Dr Cooke).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2010 American College of Chest Physicians


Chest. 2010;138(2):289-297. doi:10.1378/chest.10-0289
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Background:  Little information exists about the expected time to death after terminal withdrawal of mechanical ventilation. We sought to determine the independent predictors of time to death after withdrawal of mechanical ventilation.

Methods:  We conducted a secondary analysis from a cluster randomized trial of an end-of-life care intervention. We studied 1,505 adult patients in 14 hospitals in Washington State who died within or shortly after discharge from an ICU following terminal withdrawal of mechanical ventilation (August 2003 to February 2008). Time to death and its predictors were abstracted from the patients’ charts and death certificates. Predictors included demographics, proxies of severity of illness, life-sustaining therapies, and International Classification of Diseases, 9th ed., Clinical Modification codes.

Results:  The median (interquartile range [IQR]) age of the cohort was 71 years (58-80 years), and 44% were women. The median (IQR) time to death after withdrawal of ventilation was 0.93 hours (0.25-5.5 hours). Using Cox regression, the independent predictors of a shorter time to death were nonwhite race (hazard ratio [HR], 1.17; 95% CI, 1.01-1.35), number of organ failures (per-organ HR, 1.11; 95% CI, 1.04-1.19), vasopressors (HR, 1.67; 95% CI, 1.49-1.88), IV fluids (HR, 1.16; 95% CI, 1.01-1.32), and surgical vs medical service (HR, 1.29; 95% CI, 1.06-1.56). Predictors of longer time to death were older age (per-decade HR, 0.95; 95% CI, 0.90-0.99) and female sex (HR, 0.86; 95% CI, 0.77-0.97).

Conclusions:  Time to death after withdrawal of mechanical ventilation varies widely, yet the majority of patients die within 24 hours. Subsequent validation of these predictors may help to inform family counseling at the end of life.

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