You have forgotten your username or password, we can .My Menu Saved Items дёж–‡(з®ЂдЅ") дёж–‡(з№Ѓй«") English Deutsch н•њкµм–ґ ж—Ґжњ¬иЄћ Franais Espaol Ш§Щ„Ш№Ш±ШЁЩЉШ© Р СѓСЃСЃРєРёР№ Journal Article ANTICIPATION OF DISTRESS AFTER DISCONTINUATION OF MECHANICAL VENTILATION IN THE ICU AT THE END OF LIFE Journal Publisher Springer Berlin / Heidelberg ISSN 0342-4642 (Print) 1432-1238 (Online) Category Clinicalmentary DOI 10.Subject Collection SpringerLink Date Saturday, May 31, 2008 CLINICALMENTARY Anticipation of distress after discontinuation of mechanical ventilation in the ICU at the end of life E.O., B.Der Hoven1 and J.(1) Department of Intensive Care, Erasmus MC University Medical Center Rotterdam, P.2040, 3000 CA Rotterdam, The Netherlands RECEIVED: 21 November 2007 ACCEPTED: 20 February 2008 PUBLISHED ONLINE: 31 May 2008 Abstract Background A considerable number of patients admitted to the intensive care unit (ICU) die following withdrawal of mechanical ventilation.Discontinuation of ventilation without proper preparation, excessive respiratory secretion ismon, resulting in a 'death rattle'.Stridor can give rise to the relatives' perception that the patient is choking and suffering.Lack adequate anticipatory preparation to respond to all distressing symptoms.Methods We analyzed existing treatment strategies in distressing symptoms after discontinuation of mechanical ventilation.Conclusion The actual period of discontinuation of mechanical ventilation can be very short, but thoughtful anticipation of distressing symptoms takes time.Is an ethical responsibility to anticipate and treat (iatrogenic) symptoms such as pain, dyspnea-associated respiratory distress, anxiety, delirium, post-extubation stridor, and excessive broncho-pulmonary secretions.Makes withdrawal of mechanical ventilation in ICU patients a thoughtful process, taking palliative actions instead of fast terminal actions.Developed a flowchart covering all possible distressing symptoms that can occur after withdrawal of mechanical ventilation and extubation.Rmend a two-phase process.Hours before extubation, enteral feeding should be stopped and parenteral fluids reduced, overhydrated patients should be dehydrated with furosemide, administration of sedatives (for distress) and opioids (for pain and/or dyspnea) should be continued or started and methylprednisolone should be given in anticipation of stridor after extubation.Minutes before extubation, Butylscopolamine should be given and methylprednisolone repeated.The patient should be extubated to secure a dying process as natural as possible with the lowest burden due to distress.E.O.EMAIL: REFERENCES 1.T, Raffin TA (1995) Rapid withdrawal of support.2.ML, Bizek KS, Thill M (1999) Patient responses during rapid terminal weaning from mechanical ventilation.Care Med 27:73-77 3.G, Raffin TA (1999) Terminal weaning from mechanical ventilation.Care Med 27:9-10 4.MN, Edwards DF, Aiyagari V (2001) Factors associated with withdrawal of mechanical ventilation in a neurology/neurosurgery intensive care unit.Care Med 29:1792-1797 5.D, Rocker G, Marshall J (2003) Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit.349:1123-1132 6.KT, Anumandla PR, Foth KT (2004) Documentation of withdrawal of life support in adult patients in the intensive care unit.J Crit Care 13:328-334 7.Mahambrey T, Fowler R (2004) What factors are associated with decisions to withdraw mechanical ventilation in the intensive care unit?170:466 8.L, Weissman DE (2004) Withdrawal of ventilatory support from the dying adult patient.Support Oncol 2:283-288 9.GM, Heyland DK, Cook DJ (2004) Most critically ill patients are perceived to die infort during withdrawal of life support: a Canadian multicentre study.J Anesth 51:623-630 10.Cist AFM, Brackett SE (2001) Rmendations for end-of-life care in the intensive care unit: the ethicsmittee of the society of critical care medicine.Care Med 29:2332-2348 11.KN (2000) "Terminal" wean is the wrong term.Care Med 28:3576-3577 12.MJ, Tolle SW (1992) Disconnecting a ventilator at the request of a patient who knows he will then die: the doctor's anguish.Med 117:254-256 13.EJO, De Beaufort ID, Bakker J (2007) Euthanasia in intensive care: a 56-yeat-old man with a pontine hemorhage resulting in a locked-in syndrome.Care Med 35:2428-2430 14.K (1994) The clinical management of dying patients receiving mechanical ventilation: a survey of physician practice.15.Rubenfeld GD, Crawford SW (2001) Principles and practice of withdrawing life-sustaining treatment in the ICU.JR, Rubenfeld GD (eds) Managing death in the ICU: the transition from cure tofort.University Press, New York, pp 127-147 16.Gunten C, Weissman DE (2003) Symptom control for ventilator withdrawal in the dying patient.Palliat Med 6:774-775 17.EJO (2006) 'Death rattle' after withdrawal of mechanical ventilation: practical and ethical considerations.Crit Care Nurs 22:214-219 18.KA, Butler S, Nessly M (1989) Paralyzed with pain: the need for education.37:315-316 19.A, Manfredi PL (2000) Case presentation: undertreatment of pain: a risk associated with neuromuscular blockade in the intensive care unit.Pain Symptom Manage 19:154 20.JA, Van Delden JJM, Van der Heide A (2006) Terminal sedation and euthanasia: aparison of clinical practices.Med 166:749-753 21.TD (1990) Prevention of opioid side effects.Pain Symptom Manage 5:362-367 22.EJO, Van Zuylen C, Van der Rijt C (2006) Morphine is not a sedative and does not shorten life.Intern Med 166:2047-2048 23.ZA, Klooker T, Endert E (2004) Stress of dying is not suppressed by high-dose morphine or by dementia.24.AC, Lee KF (2002) Management of dyspnea at the end of life: relief for patients and surgeons.Am Coll Surg 194:377-386 25.ML (2004) Terminal dyspnea and respiratory distress.Care Clin 20:403-417 26.MJ (2005) Opioids and benzodiazepines appear paradoxically to delay inevitable death after ventilator withdrawal.Palliat Care 21:299-302 27.Dale A, Thornby JI (2000) Thanatophobia and opiophobia of hospice nursespared with that of other caregivers.J Hosp Palliat Care 17:15-23 28.M, Adunsky A (2004) Patterns of high-dose morphine use in a home-care hospice servive.101:1473-1477 29.A, Sykes N (1999) Opioid use in last week of life and implications for end-of-life decision making.356:398-399 30.T, Tsunoda J, Inoue S (2001) Effects of high dose opioids and sedatives on survival in terminally ill cancer patients.Pain Symptom Manage 21:282-289 31.WC, Smedira NG, Fink C (1992) Ordering and administration of sedatives and analgesics during the withholding and withdrawal of life support from critically ill patients.267:949-953 32.Daly BJ, Thomas D, Dyer MA (1995) Procedures used in withdrawal of mechanical ventilation.J Crit Care 5:331-338 33.JD, Treece PD, Engelberg RA (2004) Narcotic and benzodiazepine use after withdrawal of life support.With time of death?34.Ko S, Goldstein DH, VanDenKerkhof EG (2003) Definitions of 'respiratory depression' with intrathecal morphine postoperative analgesia: a review of the literature.J Anesth 7:679-688 35.A, Zohar E, Zaslansky R (2005) The frequency and timing of respiratory depression in 1524 postoperative patients treated with systhemic or neuraxial morphine.Clin Anesth 17:537-542 36.TH (2005) Fentanyl.Pain Symptom Manage 29:S67-S71 37.Z, van Rijn-Van der Plaat LL (2006) Fentanyl may increase breathlessness in a patient with motor neuron disease.Pain Symptom Manage 32:199-200 38.P, Shintani A, Peterson J (2006) Lorazepam is an independent risk factor for transitioning to delirium in intensive care unit patients.104:21-26 39.AH, Cerchietti LCA, Castro MA (2006) Midazolam as adjunct therapy to morphine in the alleviation of severe dyspnea perception in patients with severe cancer.Pain Symptom Manage 31:38-47 40.(2004) Pain management in the intensive care unit.Care Clin 20:381-401 41.C, Roemer-Becuwe C, Pereira J (2002) When midazolam fails.Pain Symptom Manage 23:256-265 42.C, Terry PB (1995) Neuromuscular blockade and ventilator withdrawal: ethical controversies.J Crit Care 4:112-115 43.F, Masieri S (2002) Furosemide protective effect agianst airway obstruction.Targets 3:197-201 44.J (2002) Furosemide: progress in understanding its diuretic, anti-inflammatory, and bronchodilating mechanism of action, and use in the treatment of respiratory tract diseases.J Ther 9:317-328 45.T, Jenkins K (1999) Palliative care nurses feelings about death rattle.Clin Nurs 8:615-618 46.M, Brun-Buisson C, Lemaire F (2005) Terminal extubation in 5 end-of-life patients in intensive care units.Med 34:495-501 47.CL, Cohen SL, Sjokvist P (2003) End of Life practices in European intensive care units: the Ethicus study.290:790-797 48.E, Robert R, Ingrand P (2001) Withholding and withdrawal of life support in intensive care units in France: a prospective survey.49.KC, Hou CC, Huang HC (2006) Intravenous injection of methylprednisolone reduces the incidence of postextubation stridor in intensive care unit patients.Care Med 34:1345-1350 50.KT, Conradt KL, Anumandla PR (2003) ICU nurses preparation of families for death of patients following withdrawal of ventilator support.Nurs Res 16:85-92 Find Query Builder Close Clear Within all content Within this journal Export this article Export this article as RIS Text В© Springer.Read more [membrane transport, structure, function, and biogenesis] identification of amino acid residues within the c terminus of the glut4 glucose transporter that are essential for insulin-stimulated redistribution to the plasma membrane
Get more Safety concerns prompt prime to remove avandia from formulary
