End of life in the NICU. A study of ventilator withdrawal.
OBJECTIVE
Withdrawal of ventilator support occurs commonly in the neonatal intensive care unit (NICU), but few studies have examined the process surrounding this event. This study reviewed the charts of 18 infants who died after ventilator withdrawal. Documentation of process of ventilator withdrawal, medication administration, parental participation in the decision making, and support of the family were examined.


METHODS
Retrospective chart review of all neonatal deaths during the years 1997 to 1998 in two urban hospitals with Level II and Level III NICUs. Seventy-two neonates died during that time period; 18 had died after ventilator withdrawal. Descriptive statistics were used for analysis.


RESULTS
We found a lack of clarity and consistency in the documentation in charts of infants who died after ventilator removal. Twenty-two percent of the charts had no written orders for ventilator removal; only two-thirds of the infants were receiving pain medication in conjunction with ventilator removal; 83% of the charts had a notation about parental participation in the ventilator removal. Regarding support, most charts documented support from family or clergy; however, no charts documented the emotional or social support given by nurses to the families.


CONCLUSIONS
Improved provision of and documentation of pain and symptom management upon ventilator withdrawal are needed. More clearly written orders for ventilator termination are suggested. Improved documentation of the support provided by nurses to parents of dying infants is recommended.
Abe
N
N
Kaiser Permanente, Baldwin Park, CA, USA.
Catlin
A
A
Mihara
D
D
D003643:Death; D005260:Female; D006117:Grief; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008297:Male; D017283:Neonatal Nursing; D009737:Nursing Records; D012121:Respiration, Artificial; D012189:Retrospective Studies