End-of-Life Decisions of Intracranial Hemorrhage Patients Successfully Weaned From Prolonged Mechanical Ventilation.
Chienhsiu Huang, Tsung-Hsien Wu, Jin-Cherng Chen
PMID 35333660WHAT IT FOUND
Among 91 ICH patients weaned from prolonged ventilation, families signed DNR for 62.
GCS 10 or more at discharge and no comorbidities were linked to not signing DNR. Kidney disease and GCS below 7 at respiratory care center admission were linked to dying before discharge.
Key findings
01Families signed do-not-resuscitate orders for 62 of 91 successfully weaned intracranial hemorrhage patients.
02A Glasgow Coma Scale score of 10 or more at respiratory care center discharge and zero comorbidities were more common among patients whose families did not sign a do-not-resuscitate order.
03Chronic kidney disease and a Glasgow Coma Scale score below 7 on respiratory care center admission were more common among patients who died in the general ward before discharge.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study was retrospective and came from one hospital's respiratory care center, so it may not apply to other settings. It included only 91 patients who had already been successfully weaned from prolonged mechanical ventilation, so it does not describe patients who failed weaning or died earlier. Families made do-not-resuscitate and do-not-intubate decisions, but the study did not measure what information, cultural beliefs, or caregiver burden led to those decisions. The findings are associations, not proof that chronic kidney disease, Glasgow Coma Scale scores, or hospice care caused better or worse outcomes. No tested intervention was used, so the study cannot show that ventilator withdrawal or palliative care changes survival or comfort.
Declared interests
The authors declared no potential conflicts of interest and received no financial support.
The easy way to misread this
Do not treat the chronic kidney disease and Glasgow Coma Scale score below 7 pattern as proof that hospice care or ventilator withdrawal will improve outcomes. The study was retrospective, included only 91 patients who had already been successfully weaned, and reported associations rather than tested treatment effects.