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Life Support Issues/Life Support COPD and Health Care related pneumonia

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Question
My Brother is 54 years old and is currently in the ICU for COPD, Congestive heart failure,and Health care related Pneumonia he went into complete heart failure about a week ago in the hospital and had to have CPR for five minutes. That's when he was moved to ICU and placed on life support. The hospital never called to let us know about his condition we only found out the next morning when we called!!!  Now they are depriving him of food and water they took him off the machine for about 3 days and we went back up there today and they told us they were putting him back on life support. He is supposed to have open heart surgery but now they're saying no surgeon will take him because he is considered high risk because he is also an alcoholic but they knew that 2 weeks ago and said hes They are giving him a 30% chance to survive I demanded that they let us take him home to die peacefully at home they refused and said he would never survive the trip. I guess we are just wondering what our rights are at this point if any? They re saying the pneumonia is worse and yesterday they told us the pneumonia was better and started weaning him off antibiotics. Needless to say we are devastated and don't know what to do at this point?

Answer
Tina,

I am so sorry that your family is having this sad and terrible experience. If you are your brother's health health care decision-maker (either via his Living Will or via state law, you have options.

First, I will try to address some of the confusing messages that you are getting.It sounds like both your brother's heart and lungs are failing and he has underlying liver disease. When multiple organs fail, it becomes almost impossible to recover. His labs may temporarily improve making him seem "better", but better is relative. For many patients,pneumonia occurs in ICU because patients aspirate, meaning they inhale saliva into their lungs. Their ability to swallow is impaired. This causes the pneumonia to reoccur again and again, making recovery unlikely. His ability to fight infection is already compromised due to his organ failure. To me, your brother sounds very ill and unlikely to recover.   

ICU can be a very confusing place for families. It can be very difficult to get a clear picture of how ill their loved on is. You do have options. You can ask for a family meeting with his key physicians.  You can also ask for a Palliative Care consult.  The palliative care physician can examine his case and render an unbiased opinion of your brother's ability to survive. You can also ask for a hospice consult to see what services he may be eligible for both at home and in the hospital.   

There are decisions that you can make now that will enhance his comfort. The first decision would be to shift from aggressive treatments that no longer benefit him to a focus on making him comfortable right in the ICU. Is he receiving medications regularly that will reduce any discomfort or respiratory distress? Signs of discomfort are facial grimacing or agitation when touched or moved.

Food and fluid in the final weeks of life often offers more burden than benefit. Patients bodies are not functioning properly and their bodies become very swollen with these artificial fluids. Research shows that patients are not hungry. Research shows that they do however feel thirst, but that the IV fluids do not seem to reduce this thirst. What does help the thirst, is frequent mouth care.

Once you have determined that the ventilator is prolonging his death instead of his life, a plan can be made to remove it.  Most hospitals  have a protocol for removing the ventilator while administering medications to assure patients are not distressed. Family members are usually allowed to be present.         

Important to note that CPR will likely offer little benefit. Patients may survive CPR but   survival may not be meaningful. Meaning that his overall condition will continue to decline after CPR.  Is  your family ready to issue an order that will allow him to die naturally.

I apologize for the amount of information I have provided and understand how confusing and upsetting it can be. I would seek out allies in the hospital to help you sort through this step by step. If Palliative Care or hospice care is available, they would be a big help in providing a fresh look at his case. I hope that your family finds  help and peace through all this.  

Life Support Issues

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Betsy Murphy

Expertise

My expertise is in end of life care for adults. Identifying when someone is approaching the end of their life. Benefits and burdens of end of life treatments. Managing pain and other symptoms. Providing care for dying patients at home. Advocating for someone who is dying in a hospital or nursing home.

Experience

More than 28 years of experience in hospice care. Currently consulting with hospices to promote access for patients to receive hospice care earlier in the course of their illness. Betsy provides training for hospice marketing staff to effectively work with nursing facilities to help identify eligible patients. She writes Additional Development Request (ADR) letters to Medicare to help hospices get paid for their services and to avoid future claim denials.

Organizations
Hospice and Palliative Nurses Association

Publications
Articles: Clinical Reviews, Advance for Nurses, Nursing Spectrum, Washington Business Woman, www.Ezine.com;www.alz-nca.com.Books: Understanding Medical-Surgical Nursing (FA Davis and Company), Guide to Caregiving in the Final Months of Life (TM Brown publishers).

Education/Credentials
Bachelors of Science in Nursing, additionally trained as a Family Nurse Practitioner and certified as a hospice and palliative care nurse.

Awards and Honors
Outstanding Woman in Loudoun County (VA) by Loudoun County Commission on Women 1997 and 2002.

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