| Popis: |
Palliative or compassionate withdrawal of mechanical ventilator support at the end of life aims to optimize comfort, alleviate suffering, and allow a natural death in patients for whom life supports are not achieving desired goals. Palliative withdrawal is a medical procedure and must be treated as such. Appropriate planning and preparations are required to optimize patient comfort, which is the goal of the procedure. Many institutions have a “one size fits all” approach to this process, but individual patient factors require consideration to meet the patient’s needs. Some of these factors include patient pathophysiology (airway edema, airway trauma, hemoptysis, secretions), current treatment modalities (ventilator settings, medications including sedatives, vasopressors, inotropes, inhaled agents, neuromuscular blockade agents), and patient and family values and preferences. This chapter will discuss the implications of each of these factors and propose methods for successful transitions to comfort-focused care. Case vignettes will demonstrate the thought processes involved and model optimal management. Common ethical considerations and questions regarding palliative withdrawal of life support will also be discussed. |
