Narcotic and Benzodiazepine Use After Withdrawal of Life Support

Chan, Jeannie D.; Treece, Patsy D.; Engelberg, Ruth A.; Crowley, Lauren; Rubenfeld, Gordon D.; Steinberg, Kenneth P.; Curtis, J. Randall

doi:10.1016/s0012-3692(15)32925-1

Cited by 125 publications

(111 citation statements)

References 26 publications

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“…6 Despite frequent family requests as well as expert recommendations for discussion of the postwithdrawal course, few data exist to guide clinicians in accurately conveying the anticipated course. [7][8][9] The majority of studies that examine the timing of death after withdrawal focus on patients with severe neurologic injury in the context of organ donation after cardiac death 10 or on whether the use of analgesics and sedatives during the dying process hasten death in patients who are critically ill. 7,11 These studies, among others, 12,13 dedicate little attention to other factors that may infl uence the timing of death after withdrawal of life support, such as age, severity of illness, or underlying diagnosis. Characterization of the factors that predict time to death may inform familycaregiver communication at the end of life and alleviate some of the anxiety and frustration resulting …”

mentioning

confidence: 99%

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Cooke

Hotchkin

Engelberg

et al. 2010

Chest

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A pproximately 20% of all American patients die during or shortly after a stay in the ICU, 1 the majority of whom do so in the context of a decision to forego life-sustaining therapy. [2][3][4] Once families and caregivers decide to withdraw life support, experts in end-of-life communication advocate for clinicians to inform families of what they should expect during their loved one's dying process. 5,6 This communication might include details about the expected myoclonus of dying patients, the potential for agonal respirations after discontinuation of mechanical ventilation, and the timing of death after withdrawal of life support. 6 Despite frequent family requests as well as expert recommendations for discussion of the postwithdrawal course, few data exist to guide clinicians in accurately conveying the anticipated course. [7][8][9] The majority of studies that examine the timing of death after withdrawal focus on patients with severe neurologic injury in the context of organ donation after cardiac death 10 or on whether the use of analgesics and sedatives during the dying process hasten death in patients who are critically ill. 7,11 These studies, among others, 12,13 dedicate little attention to other factors that may infl uence the timing of death after withdrawal of life support, such as age, severity of illness, or underlying diagnosis. Characterization of the factors that predict time to death may inform familycaregiver communication at the end of life and alleviate some of the anxiety and frustration resulting

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mentioning

confidence: 99%

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Cooke

Hotchkin

Engelberg

et al. 2010

Chest

Self Cite

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“…11,12 Several studies in adult and neonatal patients that did not ask about intent examined whether higher medication doses at the time of withdrawal of technological support are associated with a more rapid death, and found little relationship. [13][14][15][16][17][18] In fact, 1 study found that higher sedative doses were associated with longer survival. 19 …”

Section: Do Physicians Hasten Death?mentioning

confidence: 99%

Judging the Quality of Mercy: Drawing a Line Between Palliation and Euthanasia

Morrison¹,

Kang

2014

Pediatrics

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Clinicians frequently worry that medications used to treat pain and suffering at the end of life might also hasten death. Intentionally hastening death, or euthanasia, is neither legal nor ethically appropriate in children. In this article, we explore some of the historical and legal background regarding appropriate end-of-life care and outline what distinguishes it from euthanasia. Good principles include clarity of goals and assessments, titration of medications to effect, and open communication. When used appropriately, medications to treat symptoms should rarely hasten death significantly. Medications and interventions that are not justifiable are also discussed, as are the implications of palliative sedation and withholding fluids or nutrition. It is imperative that clinicians know how to justify and use such medications to adequately treat suffering at the end of life within a relevant clinical and legal framework. Pediatrics 2014;133:S31-S36

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“…However, several investigations have found no evidence that the appropriate use of these drugs hastens death [54][55][56], despite the ''principle of double effect'' addressing the potential for harm by use of opioids in palliative care [57]. As stated in the ATS Clinical Policy Statement on Palliative Care [23], this principle holds that relief of suffering is adequate justification for the use of opioids to control dyspnoea or pain, and that hastening death by the use of opioids, if it occurs, is morally acceptable provided that the intent of the physician or nurse is confined to relief of dyspnoea.…”

Section: Opioidsmentioning

confidence: 99%

Palliative care in COPD patients: is it only an end-of-life issue?

Carlucci

Guerrieri

Nava

2012

European Respiratory Review

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The presence of acute or chronic respiratory failure is often seen as a terminal phase of chronic obstructive pulmonary disease. A great variability in end-of-life practice is observed in these patients mainly because physicians are not always able to correctly predict survival. There is a need for a clear discussion about decision making earlier than when acute respiratory failure ensues. Indeed, a perceived poor quality of life does not necessarily correlate with a clear willingness to refuse invasive or noninvasive mechanical ventilation. It has been suggested to start palliative care earlier, together with curative and restorative care, when there is an increased intensity of symptoms. The patients eligible for palliative care are those complaining of breathlessness, pain, fatigue and depression, which in some studies accounted for a prevalence much higher than 50%. Among comfort measures for palliation, oxygen is frequently prescribed even when the criteria for long-term home oxygen therapy are not met; however, when compared with air, no benefits on dyspnoea have been found. The only drug with a proven effect on dyspnoea is morphine, but not when it is delivered with a nebuliser. Finally, noninvasive ventilation may be used only as a comfort measure for palliation to maximise comfort by minimising adverse effects.

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Narcotic and Benzodiazepine Use After Withdrawal of Life Support

Cited by 125 publications

References 26 publications

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Predictors of Time to Death After Terminal Withdrawal of Mechanical Ventilation in the ICU

Judging the Quality of Mercy: Drawing a Line Between Palliation and Euthanasia

Palliative care in COPD patients: is it only an end-of-life issue?

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