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Access Type

WSU Access

Date of Award

January 2022

Degree Type


Degree Name




First Advisor

Margaret L. Campbell


Rationale: Withdrawal of mechanical ventilation precedes many ICU deaths, yet few studies evaluated medication efficacy; opioid and benzodiazepine use is common. Purpose: Determine the effectiveness of various opioids and sedatives, as well as the impact of diagnosis, days ventilated, and demographic characteristics on respiratory comfort; Examine the impact of renal/hepatic insufficiency on medication effectiveness and respiratory comfort. Methods: Secondary analysis using the control arm of a multi-site clinical trial testing effectiveness of an algorithmic approach to ventilator withdrawal. Independent Measures: Sociodemographic, consciousness, illness severity, admitting diagnosis, chronic diagnosis, days ventilated, BUN, bilirubin, opioids, and sedatives. Dependent Measure: Respiratory Distress Observation Scale (RDOS). Analysis: Logistic regression analysis was used to explore the potential impact of different medications used. Results: (n=111) Most did not achieve comfort at the time the ventilator was turned off or thereafter. Medication use varied across sites with differences in the use of fentanyl (p<0.001), lorazepam (p=0.004), and propofol (p=0.016). Morphine was most (70%) used followed by fentanyl (60%) and lorazepam (58%). Logistic regression equations determined that patients were 2.68 times less likely to achieve respiratory comfort with lorazepam use (p=0.039). BUN levels were higher for those who achieved comfort (p = 0.050). Bilirubin levels were higher in those who achieved comfort compared to those who did not, but the difference was not statistically significant (p = 0.510). Conclusion: Benzodiazepines continue to be used to treat respiratory distress at the end of life without efficacy. Renal function impacts medication metabolism such that comfort is achieved with less medication. Local practice customs continue to guide management, yet treatment standardization may be ideal to achieve respiratory comfort in this context.

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