Critical Care and Life Support
The purpose of life support is to support or augment failing body organs. Examples include ventilators for the lungs; dialysis machines for the kidneys; electric shock for the failing heart; and tube feedings for the patient unable to eat. In general, life support is a temporary measure simply meant to help a patient recover from an injury, surgery or serious illness. However, in some situations, life support takes on a "life of its own." Instead of being a means to support the patient while he or she heals or adapts to an altered function, it becomes the lifeline for the patient.
When patients are no longer able to make healthcare decisions, one of the most challenging decisions a healthcare surrogate or family member(s) might be faced with is whether or not to introduce or continue life support of their loved one. Decisions regarding life support are highly personal and should be based on honoring the wishes of the individual patient as communicated by the patient, if competent to do so, or if not, then as expressed in an Advance Directive and/or as communicated to the medical staff by the patient's healthcare surrogate, the patient's next of kin, if no healthcare surrogate has been named by the patient, or by a legal guardian.
Generally, there are three levels of care to consider.
- Full Support: This includes the use of any and all appropriate treatments to preserve life and increase the patient's chances of a full recovery. This includes, but is not limited to: CPR (Cardiopulmonary Resuscitation), defibrillation and chest compressions if the patient suffers cardiac arrest (the heart stops beating) or respiratory arrest (the patient stops breathing.)
- Conditional Support and Allow Natural Death: This allows patients, if competent, or if not, healthcare surrogates, next of kin, or legal guardians to determine with the advice of the patient's physician(s) which interventions to utilize to restore or maintain function as the patient's needs change. Other measures can and will be done as deemed appropriate unless the patient suffers a cardiac or respiratory arrest in which case no CPR or chest compressions will be performed and the patient will be allowed to die naturally.
- Comfort Support and Allow Natural Death: This allows patients, if competent, or if not, healthcare surrogates, next of kin or legal guardians to determine with the advice of the patient's physician(s) that therapeutic measures will be used to alleviate suffering and maximize the comfort and dignity of the patient. As with the Conditional Support, no CPR or chest compressions will be performed if the patient suffers cardiac arrest or respiratory arrest. The focus is on providing care needed to enhance comfort, dignity and a sense of wellbeing. Examples of comfort support measures may be morphine or other pain management and oxygen PRN. Healthcare providers will allow the patient to die naturally while providing comfort and support to both patient and family.
The following are words you may hear during treatment for your loved one:
- CPR -- Cardiopulmonary Resuscitation.
- BLS/ACLS -- Procedures used by trained individuals to attempt to restart someone’s heart and/or breathing. This can include artificial breathing, chest compressions and electrical shocks (defibrillation).
- Defibrillation -- Electrical shocks sent through the chest wall to the heart.
- Vasopressors -- A group of drugs used to raise a patient’s blood pressure, which necessitates close monitoring by staff.
- Tube feeding -- A means of artificial (eating) nutrition and hydration (drinking). Can be done by placing a tube through the nose or throat, or surgically through the stomach or abdomen.
- Intravenous (IV) feeding -- Can take the form of Total Parenteral Nutrition (TPN) and/or IV fluids. Artificial nutrition and hydration can be very valuable and life saving, but in dying patients, can have harmful side effects and can actually prolong suffering.
- Mechanical ventilation (MV) -- Breathing done by the assistance of a ventilator (breathing machine). This is done by inserting a breathing tube through the patient’s nose or mouth. A tracheotomy may be performed to allow for prolonged MV with less discomfort for the patient. MV is a form of life support.
- Dialysis -- Artificial means to clean and remove excess fluids and waste products from the blood. This can replace or supplement the work of the kidney.
- Pacemaker -- Is a device that can be temporary or permanent, which supplies electrical current to the heart to stimulate it to beat.
- Implantable Cardioverter Defibrillator (ICD) -- A device used to shock a patient’s heart back into a regular or life-sustaining rhythm.
If your family member has an advance directive, please be sure staff is aware and have copies of any documentation on the chart. If no legal documents are available, then as a family (if the patient is unable to decide for him/herself) you should discuss any known preferences of the patient.
Unfortunately, many people fail to formalize their wishes by means of advance directives. We have specially trained critical care doctors/intensivists who can help you make informed decisions.
Our hospital has a specially designed unit for patients/families who have decided on comfort care measures only. 2 South has specially trained staff focused on meeting the needs of the patients/families at this unique time in their lives. We have a Palliative Care Team comprised of two RNs, a social worker and a chaplain who may be consulted to help in the decision-making process to facilitate with the transition to 2 South, if appropriate.
Many sources of information are available to patients and families:
- The National Self-Help Clearinghouse at 212-642-2944
- Hospice at 1-800-331-1620
If you have any questions regarding the care of your loved one, please ask the nurse or physician.