Reasons why the clinician decided to administer medication after mechanical ventilation had been withdrawn
| Slight distress and movement. | More alert, mild distress. | Respiratory rate 40, patient trying to speak, looked in acute distress and frightened. | Although thought to probably be comfortable, he had subtle flickering of eyelids—not clear if it represented reflex/involuntary movements or distress. Brow smooth. |
| Transient twitching of mouth and one eye open briefly. Very brief movement of mouth and eye after 5 min, gave preprepared medication subcutaneously. Response settled spontaneously within a minute. | Eyes open, peripheral cyanosed breathing appeared an effort. Distressed. | He started deteriorating after 30 min. Tachypnoea, secretions, respiratory rate 28, distressed. | |
| Distress. | Patient roused and asked for help. Patient appeared restless. Not fully settled. | Grimacing. | Appeared distressed, change in facial expression, open eyes, altered breathing. |
| Anxiety and shortness of breath . | Laboured breathing, although not obviously distressed. | Patient showed signs of distress. | Eyes opened, appeared distressed. |
| Respiratory distress, gasping, some agitation. | Not drowsy enough, slightly agitated. | On switching off machine, patient appeared distressed and moved his arms. | Although thought to probably be comfortable, he had subtle flickering of eyelids—not clear if it represented reflex/involuntary. |
| Looked unsettled and family starting to get anxious that he was distressed. | Heavier breathing, doses administered as mask came off. | Became a little agitated. | More alert and moving arms. |
| Sedation. | Patient comfort. | Movements or distress. Brow smooth. | Moved eyebrows. |