ICU clinicians’ experiences of terminal weaning and extubation

Shelly Orr, Nikolaos Efstathiou, Marianne Baernholdt, Brandi Vanderspank-Wright

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Context: Aside from spontaneous death, a majority of ICU deaths occur after a decision to either withhold or withdraw life-sustaining measures, including withdrawal of ventilatory support. While terminal weaning or terminal extubation are both used, the lack of evidence on the superiority of one method over the other can create challenges for ICU clinicians. There is a need to explore clinicians’ experiences related to terminal weaning/extubation to understand their decision-making processes as well as the context and mechanisms that guide this process.

Objectives: This study aimed to explore ICU clinicians’ experiences of Terminal Weaning of Mechanical Ventilation (TWMV) in order to better understand the process, and clinicians’ feelings about the process.

Methods: This study used an exploratory descriptive qualitative design. Data were collected via semi-structured, face-to-face interviews with 20 ICU clinicians. An inductive, data driven thematic analysis approach was used for data analysis.

Results: Analysis of the data resulted in four themes: Fine-tuning the Process of TWMV; Focusing on the Family; Ensuring Patient-Centered Care; and Impact on Healthcare Clinicians and Support Needs.

Conclusions: The identified themes provide insight into the complexity of the withdrawal of mechanical ventilation within the context of end-of-life care in the ICU. The themes highlight the need for clear communication of a TWMV plan between clinicians to avoid conflict during the process, ensuring medication is in place for potential distressing symptoms, incorporating patient and family wishes in planning, supporting the family during the process, and training and support for clinicians.
Original languageEnglish
Pages (from-to)e521-e528
JournalJournal of Pain and Symptom Management
Issue number5
Early online date31 Jan 2022
Publication statusE-pub ahead of print - 31 Jan 2022


  • Intensive Care
  • Interviews
  • Qualitative
  • Terminal Extubation
  • Terminal Weaning
  • end-of-life


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