Terminal Withdrawal of Mechanical Ventilation in a PICU

Objectives: Data regarding a terminal withdrawal of mechanical ventilation in pediatric patients, in particular the time-to-death, would be helpful to family and hospital staff. Methods: This retrospective case series will review the terminal withdrawal of mechanical ventilation in PICU patients at our hospital between 2015 and 2020. Results: There were 222 PICU deaths and 53 of these patients died following a terminal withdrawal of mechanical ventilation. The time-to-death was <1 hour in 37>patients, from 1 to 24 hours in 12 patients, and >24 hours in 4 patients. Neither age nor the duration of mechanical ventilation prior to terminal withdrawal of mechanical ventilation was associated with time-to-death. Terminal withdrawal of mechanical ventilation was complicated by concurrent withdrawal of cardiac support devices in 9 patients and by a recent cardiac arrest in 3 patients (1 of whom also had a cardiac support device withdrawal), and the time-to-death for these 11 patients was less than one hour (p=0.01 vs. all others). The time-to-death for those without concurrent withdrawal of cardiac support devices or recent cardiac arrest was shorter in those with a higher fraction of inspired oxygen but was not associated with positive end expiratory pressure. Conclusions: Time-to-death following a terminal withdrawal of mechanical ventilation was less than a day in more than 90% of our patients and was not associated with patient age or the duration of mechanical ventilation. However in patients without a recent cardiac arrest or concurrent withdrawal of cardiac support devices nearly one in ten survived a terminal withdrawal of mechanical ventilation for more than a day, while those with a recent cardiac arrest or concurrent withdrawal of cardiac support devices survived for less than an hour.