Terminal Weaning
1995; Elsevier BV; Volume: 108; Issue: 5 Linguagem: Inglês
10.1378/chest.108.5.1405
ISSN1931-3543
Autores Tópico(s)Ethics in medical practice
ResumoPhysicians often withdraw patients from mechanical ventilators when therapy has been judged futile or the patient requests discontinuation. Withdrawal occurs in two ways: physicians either extubate patients immediately or wean them over a period of hours (terminal weaning). There is little data to determine which method is truly superior: “rationales of patient comfort and family perceptions remain matters of individual experience.” 1 Faber-Langendoen K The clinical management of dying patients receiving mechanical ventilation: a survey of physician practice. Chest. 1994; 106: 880-888 Abstract Full Text Full Text PDF PubMed Scopus (115) Google Scholar Although more data regarding patient comfort may be helpful to physicians, the process of discontinuing mechanical ventilation is so clinically and emotionally complex for physicians, patients, and families that I suspect it will always remain a highly individualized experience. In light of this belief, I would like to explain why I generally favor withdrawing patients from ventilators over hours or days rather than extubating the patient immediately. Rapid Withdrawal of SupportCHESTVol. 108Issue 5PreviewWhile much debate has transpired over the ethics of whether to withdraw life support from terminally ill patients, little attention has been paid to the question of how to withdraw support. In the preceding essay, Gianakos compares prolonged terminal weaning with extubation, but other, more humane, alternatives exist. Further, Gianakos contends that after a decision has been reached to withdraw life support, a gradual weaning of mechanical ventilation over several hours or days allows for more precise titration of narcotics and therapy, allows the physician more time to comfort the patient and family during the withdrawal, diminishes the emotional difficulty physicians may experience during the withdrawal, and maintains a “positive uncertainty' about the patient's outcome.” While we find his essay thoughtful, and timely, we take issue with his conclusion and believe that a rapid reduction of ventilatory support represents both a more ethical and a more rational approach to the termination of life support. Full-Text PDF
Referência(s)