Palliative Withdrawal of Mechanical Ventilation in Critically Ill Patients:
DOI:
https://doi.org/10.33755/jkk.v12i4.1051Keywords:
End-of-Life-Care, Intensive Care Unit, Palliative Care, palliative extubatio, Mechanical Ventilation, palliative withdrawal of mechanical ventilationAbstract
Background: Palliative withdrawal of mechanical ventilation is an important component of end-of-life care for critically ill patients when life-sustaining treatment no longer provides meaningful clinical benefit or is no longer consistent with the patient's goals of care. Its application in end-of-life care remains challenging because it involves clinical, ethical, communication, and multidisciplinary considerations.
Objective: This review aimed to map recent evidence on palliative withdrawal of mechanical ventilation in critically ill patients and to examine practice-relevant themes and implications for nursing care.
Methods: A structured narrative search of PubMed, ScienceDirect, and Google Scholar mapped literature published between 2023 and 2025. The Population, Concept, and Context framework guided eligibility. The evidence map contained two primary withdrawal-specific studies and three contextual reviews. Sources were interpreted according to study design and directness; the synthesis did not estimate comparative effects.
Results: Among five mapped publications, two primary studies examined clinician perspectives on withdrawal and three review-level sources provided contextual information. Six a priori domains organized the narrative synthesis: therapeutic communication, shared decision-making, advance care planning, symptom management, family support, and multidisciplinary collaboration. Direct evidence was concentrated on communication, withdrawal processes, symptom management, and teamwork.
Conclusion: Palliative ventilator withdrawal is a planned, comfort-focused care process requiring continued nursing assessment, team coordination, and support for relatives. Because the evidence base was small, heterogeneous, and predominantly descriptive, the six domains should be understood as provisional practice considerations rather than a validated withdrawal protocol.
References
1. Crawford GB, Dzierżanowski T, Hauser K, Larkin P, Luque-Blanco AI, Murphy I, et al. Care of the adult cancer patient at the end of life: ESMO Clinical Practice Guidelines. ESMO Open. 2021;6(4):100225. doi:10.1016/j.esmoop.2021.100225.
2. World Health Organization. Implementing the World Health Assembly resolution on palliative care [Internet]. Geneva: WHO; 2021 Oct 12 [cited 2026 Sep 7]. Available from: https://www.who.int/news/item/12-10-2021-implementing-world-health-assembly-resolution-on-palliative-care
3. Astuti NP, Sriyono S, Yunitasari E, Kurniawati ND, Baidhowy AS. Dilemma of identification patients palliative care needs in critical care unit. Indones J Glob Health Res. 2024;6(1):263-272. doi:10.37287/ijghr.v6i1.2664.
4. Antika R, Adhisty K, Latifin K. Paker digital application in making palliative nursing care. J Berita Ilmu Keperawatan. 2023;16(1):1-10. doi:10.23917/bik.v16i1.19055.
5. Zamharira R, Trisyani Y, Emaliyawati E. Palliative care implementation in the intensive care unit: a literature review. J Keperawatan. 2023;14(2). doi:10.35730/jk.v14i2.1023.
6. Martina D, Kustanti CY, Dewantari R, Sutandyo N, Putranto R, Shatri H, et al. Advance care planning for patients with cancer and family caregivers in Indonesia: a qualitative study. BMC Palliat Care. 2022;21:204. doi:10.1186/s12904-022-01086-0.
7. Eng MC, Hewitt J, Kekalih A, et al. Preference for initiation of end-of-life care discussion in Indonesia: a qualitative study. BMC Palliat Care. 2022;21:18. doi:10.1186/s12904-021-00894-0.
8. Ortega-Chen C, Van Buren N, Kwack J, Mariano JD, Wang SE, Raman C, et al. Palliative extubation: a discussion of practices and considerations. J Pain Symptom Manage. 2023;66(2):e219-e231. doi:10.1016/j.jpainsymman.2023.03.011.
9. Bryan AF, Reich AJ, Norton AC, Campbell ML, Schwartzstein RM, Cooper Z, et al. Process of withdrawal of mechanical ventilation at end of life in the ICU: clinician perceptions. CHEST Crit Care. 2024;2(2):100051. doi:10.1016/j.chstcc.2024.100051.
10. Elverson J, Evans H, Dewhurst F. Palliation, end of life care and ventilation withdrawal in neuromuscular disorders. Chron Respir Dis. 2023;20:14799731231175911. doi:10.1177/14799731231175911.
11. Efstathiou N, Diridis FKM, Orr M, Baernholdt M, Vanderspank-Wright B. Intensive care clinicians' experiences of palliative withdrawal of mechanical ventilation: a qualitative study. BMJ Open. 2025;15(8):e096527. doi:10.1136/bmjopen-2024-096527.
12. Salins N, Dhyani VS, Mathew M, Prasad A, Rao AP, Damani A, et al. Assessing palliative care practices in intensive care units and interpreting them using the lens of appropriate care concepts: an umbrella review. Intensive Care Med. 2024;50(9):1438-1458. doi:10.1007/s00134-024-07565-7.
13. Marshall MF, Davis FD, Fogelman PA, Oczkowski S, Reid JC, Arellano D, et al. Society of Critical Care Medicine clinical practice guidelines on adult end-of-life care in the ICU. Crit Care Med. 2025;53(12):e2734-e2746. doi:10.1097/CCM.0000000000006856.
14. Kesecioglu J, Rusinova K, Alampi D, Arabi YM, Benbenishty J, Benoit D, et al. European Society of Intensive Care Medicine guidelines on end of life and palliative care in the intensive care unit. Intensive Care Med. 2024;50(11):1740-1766. doi:10.1007/s00134-024-07579-1.
15. Mazzu MA, Campbell ML, Schwartzstein RM, White DB, Mitchell SL, Fehnel CR. Evidence guiding withdrawal of mechanical ventilation at the end of life: a review. J Pain Symptom Manage. 2023;66(3):e399-e426. doi:10.1016/j.jpainsymman.2023.05.009.
16. Meilando R, Kosasih CE, Emaliyawati E. Barriers and challenges of end-of-life care implementation in the intensive care unit: literature review. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2022;8(1). doi:10.33755/jkk.v8i1.296.
17. Mintarto PE, Fauzi A. Nurse’s experience in caring end-of-life patients in intensive care unit RSPI Prof. Dr Sulianti Saroso Jakarta year 2021. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2022;8(1). doi:10.33755/jkk.v8i1.312.
18. Jelly P, Rochmawati E. Interventions to improve nurse therapeutic communications in the context of palliative care: literature review. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2022;8(3). doi:10.33755/jkk.v8i3.300.
19. Zhu N, Yang L, Wang X, Tuo J, Chen L, Deng R, et al. Experiences and perspectives of healthcare professionals implementing advance care planning for people suffering from life-limiting illness: a systematic review and meta-synthesis of qualitative studies. BMC Palliat Care. 2023;22:55. doi:10.1186/s12904-023-01176-7.
20. Crooks J, Trotter S, Patient Public Involvement Consortium, Clarke G. How does ethnicity affect presence of advance care planning in care records for individuals with advanced disease? A mixed-methods systematic review. BMC Palliat Care. 2023;22:43. doi:10.1186/s12904-023-01168-7.
21. Campbell ML, Yarandi HN. Effectiveness of an algorithmic approach to ventilator withdrawal at the end of life: a stepped wedge cluster randomized trial. J Palliat Med. 2024;27(2):185-191. doi:10.1089/jpm.2023.0128.
22. Checa-Checa A, Medina-Maldonado V, Ramírez A, Rodríguez Diez J. Family support strategies during intensive care unit: a systematic review. Inquiry. 2025;62:00469580251368654. doi:10.1177/00469580251368654.
23. Utami RS, Pujianto A, Setyawan D, Naviati E, Rochana N. Critical care nurses’ experiences of end-of-life care: a qualitative study. Nurse Media Journal of Nursing. 2020;10(3):260-274. doi:10.14710/nmjn.v10i3.31302.
24. Alanazi NH. Intensive care unit nurses’ experiences in caring for end-of-life patients in Saudi Arabia: a qualitative study. International Journal of Environmental Research and Public Health. 2024;21(7):931. doi:10.3390/ijerph21070931.
25. Jensen HI, Rasmussen CK, Haberlandt TN, Jensen SS. End-of-life issues experienced by the nurse-led rapid response team: an analysis of extent and experiences. Intensive and Critical Care Nursing. 2023;76:103411. doi:10.1016/j.iccn.2023.103411.
26. Agustina R, Romadhon PZ, Lin MF. Strengthening palliative care systems in Indonesia: a strategic policy brief to address health system gaps. Jurnal Keperawatan Komprehensif (Comprehensive Nursing Journal). 2025;11(3):405-410. doi:10.33755/jkk.v11i3.888.
