# An Algorithmic Approach to Ventilator Withdrawal at the End of Life

> **NIH NIH R01** · WAYNE STATE UNIVERSITY · 2021 · $226,908

## Abstract

DESCRIPTION (provided by applicant): Terminal ventilator withdrawal is a process that entails the cessation of mechanical ventilatory support with patients who are unable to sustain spontaneous breathing and is commonly performed in the ICU. Ventilator withdrawal is undertaken to allow a natural death. Opioids and/or benzodiazepines are administered before, during, and after as an integral component of the ventilator withdrawal process to prevent or relieve respiratory distress, but there are few guidelines to determine how much to administer or when. Insufficient opioid and/or benzodiazepine administration places the patient at risk for unrelieved respiratory distress and preventable suffering. Conversely, excessive medication administration may hasten death, an unintended consequence, and one that concerns clinicians. The effective doses of medications given during ventilator withdrawal are unknown. We hypothesize that an algorithmic approach to ventilator withdrawal, relying on a biobehavioral instrument to measure and trend distress, will ensure patient comfort, and guide effective opioid and/or benzodiazepine administration. We plan to use a stepped wedge cluster randomized controlled trial with all clusters providing unstructured usual care until each cluster is randomized to implement the algorithmic approach (intervention). The proposed study is innovative because there is no standardized, evidence-based approach guided by an objective measure of respiratory distress to this common ICU procedure. The study has broad clinical significance to provide knowledge that can potentially reduce patient suffering.

## Key facts

- **NIH application ID:** 10004721
- **Project number:** 5R01NR015768-05
- **Recipient organization:** WAYNE STATE UNIVERSITY
- **Principal Investigator:** Margaret Lorene Campbell
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $226,908
- **Award type:** 5
- **Project period:** 2016-09-27 → 2022-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10004721

## Citation

> US National Institutes of Health, RePORTER application 10004721, An Algorithmic Approach to Ventilator Withdrawal at the End of Life (5R01NR015768-05). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10004721. Licensed CC0.

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