The ARREVE-3 trial will evaluate whether a structured palliative care protocol can improve end-of-life management for mechanically ventilated ICU patients in whom a decision to withdraw life-sustaining therapies has been made. This cluster-randomized controlled trial compares protocol-based care with usual practice across participating centers. The intervention includes comprehensive guidance on symptom management, sedation, nursing care, withdrawal procedures, and family support, supported by standardized staff training. The primary endpoint is adherence to recommended end-of-life practices, while secondary outcomes assess patient comfort, communication with relatives, and the impact on families and healthcare professionals
Age ≥ 18 years
ICU admission for more than 48 hours
Receiving invasive mechanical ventilation
A documented decision to withdraw life-sustaining therapies, made through a multidisciplinary collegial process and communicated to the designated surrogate decision-maker, family, or relatives
Presence of a tracheostomy
Brain death or involvement in an organ donation procedure
Absence of any visit from a relative
Subject to legal guardianship or other legal protection measures
Nantes University Hospital
Lead sponsor
University of Burgundy
Collaborator
Centre Hospitalier Universitaire de Saint Louis APHP
Collaborator
University Hospital, Tours
Collaborator