Expert: Hillarie Speziale - 12/5/2008

Question
Hi-
My mother has been receiving food through a feeding tube from her nose to her stomach..for about a week now. She had heart failure and c.p.r. revived her about a week and a half ago. Now she is on a ventilator and a feeding tube.
The doctor says the feeding tube is breaking down my mother's skin with pressure sores.
The doctor wants to do a tracheotomy and gastronomy but doesn't feel my mother will have a good quality life. She does open and close her eyes and move them from side to side now..something she didn't do before. She appears to be more responsive. She will lift her head when coughing or suctioning of the ventilator tube she moves her legs despite fractured hip and broken ribs from c.p.r. The nurses say she isn't getting any sedatives yet she is resting most of the time. They have tried to wean her off the ventilator and she doesn't adapt well to that whatsoever. The doctor is persistant about a decision for my mother let nature take it's course or a trachestomy and gastromony. I only want to make an informed decision. Your professional opion and anwer would be greatly appreciated.

Mark

Answer
Hi Mark,
  I'm sorry to hear about your mom. This must be a very difficult time for you. The feeding tube will cause pressure sores especially on the inside of her nose. It is possible to put in a small bore feeding tube, however, the gastrostomy tube placement is a very quick and simple procedure that will allow her to be fed and will also reduce her risk of aspirating the tube feed. It is a more permanent and more comfortable solution. And, if need be, it can be reversed again.
  The tracheostomy tube is similar in that it can easily be placed, and can be reversed as well. Recent studies have shown patients do better and make a more quick recovery when the tracheostomy is performed early in the illness. There are many advantages to the tracheostomy. It makes it easier to wean the patient from the ventilator as there is less distance to move the air. Also, if the patient is able, they can eat with the tracheostomy while still on the ventilator. They are also able to speak even before the tracheostomy is reversed.
  These two will give her the best chance of recovery from this illness. If you want everything done for her, and want her to have every chance to survive, this would be the best option.
  It is worrisome that she has not regained full consciousness over the past week. Has she had a neurology consult to ascertain if she suffered any neurologic injury as a result of her cardiac arrest? It may shed some light on all this.
  One of the most basic questions is to ask not what you should do, but what is it your mother would want. Would she be willing to live on the ventilator as long as needed. If it were going to be long term, will she say, " Yes, life at any price". Was she a very independent person, who will not be happy to be tied to a breathing machine? Is she a very private woman so that it would bother her to have someone else cleaning and caring for her all the time? Did she ever suggest what she wanted?

Take a little time for yourself as you try to answer these questions. Take care of yourself, Hillarie