Providing palliative care for patients receiving mechanical ventilation in an intensive care unit Part 2: Withdrawing ventilation

2005 ◽  
Vol 13 (3) ◽  
pp. 133-137 ◽  
Author(s):  
Christopher E. Cox ◽  
Joseph A. Govert ◽  
Hasan Shanawani ◽  
Amy P. Abernethy
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Palliative Care ◽  
Intensive Care

scholarly journals The Truth, the Whole Truth, and Nothing but the Truth: Therapeutic Privilege

2021 ◽  
Author(s):  
Manar Shalak ◽  
Masood Shariff ◽  
Varun Doddapanini ◽  
Natasha Suleman
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Palliative Care ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Palliative Care Team ◽  
Medical Field ◽  
Ethical Implications ◽  
Therapeutic Privilege ◽  
To Receive

Abstract The term therapeutic privilege is unfamiliar in the medical field and often sparks questions and discomfort about its ethical implications. Therapeutic privilege refers to the act of withholding of information by a clinician, with the underlying notion that the disclosure of this information would inflict harm or suffering upon the patient1. This is a case of a 56-year-old woman who presented to our facility in critical condition: sepsis with acute respiratory failure requiring intubation and mechanical ventilation. Prior to her admission, her husband had been admitted at our facility and was being cared for in the intensive care unit. On the same day that our patient was extubated, her husband had died. The palliative care team was consulted to assist with disclosing this information to the patient in light of her emotional fragility, her anxiety and concerns for her ability to receive such news given her own active illnesses.

scholarly journals Effects of hospice palliative care on medical service utilisation by patients on prolonged mechanical ventilation: A nationwide cohort study

2021 ◽  
Author(s):  
Chin-Jung Liu ◽  
Yeong-Ruey Chu ◽  
Chia-Chen Chu ◽  
Pei-Tseng Kung ◽  
Wei-Yin Kuo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Palliative Care ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Prolonged Mechanical Ventilation ◽  
Hospitalisation Cost ◽  
Total Hospitalisation ◽  
Hospice Palliative Care ◽  
Total Hospitalisation Cost

Abstract Background: Several studies have shown that hospice palliative care interventions for cancer patients can reduce medical utilisation. In Taiwan, 20–25% of mechanical ventilation patients have been on prolonged mechanical ventilation (PMV), but only a few studies have discussed the effectiveness of hospice palliative care on these patients. This study aimed to explore the effectiveness of medical utilisation on patients undergoing PMV in hospice palliative care.Methods: From the Health Insurance database of a nationwide population-based study, we identified patients who had been on mechanical ventilation for over 21 days, were 18 years or older between 2009 to 2017, and had undergone hospice palliative care. The control group was obtained by 1:1 matching using propensity scoring after excluding patients who had participated in palliative care for less than 15 or more than 181 days. Furthermore, we used conditional logistic regression analysis to explore intensive care unit readmission, emergency department presentation, and cardiopulmonary resuscitation incidents, 14 days prior to death.Results: A total of 186,533 new PMV patients aged ≥ 18 years with terminal diseases were admitted between 2009 and 2017. Additionally, the number of patients receiving palliative care increased annually, from 0.6% in 2009 to 41.33% in 2017. The number of prolonged mechanical ventilation during emergency visits (odds ratio [OR]=0.68, 95%CI: 0.63-0.74), intensive care unit hospitalisation (OR=0.59, 95%CI: 0.53-0.46), cardiopulmonary resuscitation (OR=0.40, 95%CI: 0.35-0.46), and total hospitalisation cost (USD 1319.9.57 ± 1821.67 vs. 1544.37 ± 2309.27) was lower in the palliative care group.Conclusion: Patients undergoing PMV whilst in hospice palliative care can significantly reduce total hospitalisation cost, intensive care unit admittance, cardiopulmonary resuscitation utilisation, and medical expenses at ≤14 days prior to death.

scholarly journals Respiratory Modalities in Preventing Reintubation in a Pediatric Intensive Care Unit

2021 ◽  
Vol 8 ◽  
pp. 2333794X2199153
Author(s):  
Ameer Al-Hadidi ◽  
Morta Lapkus ◽  
Patrick Karabon ◽  
Begum Akay ◽  
Paras Khandhar
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Noninvasive Positive Pressure Ventilation ◽  
Pediatric Intensive Care ◽  
Nasal Cannula ◽  
Respiratory Support ◽  
Positive Pressure ◽  
P Value

Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Derivation and validation of a search algorithm to retrospectively identify mechanical ventilation initiation in the intensive care unit

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Nathan J Smischney ◽  
Venu M Velagapudi ◽  
James A Onigkeit ◽  
Brian W Pickering ◽  
Vitaly Herasevich ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Search Algorithm

scholarly journals Age, Frailty, Resuscitation and Intensive Care: With Reference to COVID-19

Geriatrics ◽  
2021 ◽  
Vol 6 (2) ◽  
pp. 36
Author(s):  
David G Smithard ◽  
Nadir Abdelhameed ◽  
Thwe Han ◽  
Angelo Pieris
Keyword(s):  
Intensive Care Unit ◽  
Decision Making ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Cardiopulmonary Resuscitation ◽  
Distributive Justice ◽  
Older Age ◽  
Distribution Of Resources ◽  
Utilitarian Approach ◽  
The Individual

Discussion regarding cardiopulmonary resuscitation and admission to an intensive care unit is frequently fraught in the context of older age. It is complicated by the fact that the presence of multiple comorbidities and frailty adversely impact on prognosis. Cardiopulmonary resuscitation and mechanical ventilation are not appropriate for all. Who decides and how? This paper discusses the issues, biases, and potential harms involved in decision-making. The basis of decision making requires fairness in the distribution of resources/healthcare (distributive justice), yet much of the printed guidance has taken a utilitarian approach (getting the most from the resource provided). The challenge is to provide a balance between justice for the individual and population justice.

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