# Intensive Palliative Care: Improving the Process of Palliative Ventilator Withdrawal Among Critically Ill Older Adults

> **NIH NIH K23** · HEBREW REHABILITATION CENTER FOR AGED · 2021 · $194,400

## Abstract

Nearly 25% of Americans die in intensive care units (ICUs), the largest proportion of whom are older persons
with advanced illness. Most deaths in ICUs are expected and involve the removal of ventilator support, or
palliative ventilator withdrawal (PVW). Prior work by the Principal Investigator (PI) found more than two-thirds
of ICU patients undergoing PVW were over age 60. Moreover, there are unique management considerations
when transitioning an older ICU patient to comfort care, including for the PVW process (e.g. choice and dose of
drugs to alleviate distressing symptoms and approach to agitated delirium). While research conducted over the
past 15 years has informed several aspects of palliative care in the ICU, relatively little of that work has
focused on PVW. As such, PVW practices vary widely, and patient suffering is common; 30-59% of terminally
extubated patients experience dyspnea. Thus, experts and national organizations have called for evidence to
inform guidelines for PVW, an area of particular relevance to older patients. The over-riding objective of the
proposed research is to generate the evidence-base to improve PVW in older ICU patients. The Specific Aims
are: 1. To better understand the patient experience and providers’ perspectives, 150 mechanically ventilated
ICU patients over 60 years old will be recruited and prospectively followed in two Boston hospitals (180 beds)
undergoing PVW. 2. To develop and refine a Comfort Measures Only Time out (CMOT) intervention consisting
of a structured time out with check-list protocol for the ICU team (nurse, physician, respiratory therapist) to
improve the process of PVW. 3. To pilot test the CMOT intervention in 4 ICUs (2 medical/2 surgical) among 40
PVW patients. Impact: By rigorously characterizing the experience of older ICU patients undergoing PVW, and
developing and pilot testing a novel CMOT intervention, the proposed work will generate the much need
evidence base to improve the care provided to this vulnerable population. Findings will directly inform the
design of a larger RCT (R01) to fully evaluate the intervention. This work will establish the PI as an
independent investigator with unique skills conducting palliative care intervention research among older adults
in the ICU setting.

## Key facts

- **NIH application ID:** 10143172
- **Project number:** 5K23AG066929-02
- **Recipient organization:** HEBREW REHABILITATION CENTER FOR AGED
- **Principal Investigator:** Corey R Fehnel
- **Activity code:** K23 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $194,400
- **Award type:** 5
- **Project period:** 2020-04-15 → 2025-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10143172

## Citation

> US National Institutes of Health, RePORTER application 10143172, Intensive Palliative Care: Improving the Process of Palliative Ventilator Withdrawal Among Critically Ill Older Adults (5K23AG066929-02). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10143172. Licensed CC0.

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