In the study population of 851 patients receiving mechanical ventilation, almost 20% had mechanical ventilation withdrawn.
Factors making discontinuation of mechanical ventilation more likely:
(1) ongoing need for vasopressors or inotropes
(2) poor chances (< 10%) of surviving to discharge from the ICU
(3) high probability of no or severely limited cognitive function 1 month after discharge from the ICU
(4) patient's preference for advanced life support is for none or for limited use
where:
• The need for vasopressors or inotropes suggests cardiac failure, the need for mechanical ventilation respiratory failure, and poor cognitive function neurologic failure. The presence of all 3 suggests a patient with multi-organ failure.
• The limited cognitive function at 1 month presumably is unlikely to get better.
• If the patient is unconscious or has left no written guidance then the family or designated decision maker must decide what the patient's preferences for life support might be.
• If all 4 factors are present, the cumulative product of the hazard ratios (from Table 4, page 1130) is 66.
