Question

When should life-sustaining treatments like breathing machines or feeding tubes be started, continued, or stopped?

Answer 1

Life sustaining treatment refers to the treatment that initiated to extend the life. Life sustaining treatment includes artificIal nutrition,hydration and assistive devices.

Cardiopulmonary resuscitation, Mechanical ventilation, Pacemaker, Left ventricular devices,Parenteral nutriiton,hydration therapy helps the person to revert from life threatening conditions.

Cardiopulmonary resuscitation:

- CPR is an emergency procedure that combines chest compressions and artificial breathing. It is done during an episode of cardiac arrest to support circulatory flow and oxygenation.

Indications:

Cardiac arrest, Ventricular fibrillation,pulseless electrical activity,Asystole,pulselss bradycardia,unconscious.

Mechanical ventilation:

- It is a life sustaining measures to improve patient ventilation. The common indications for mechanical ventilation are : respiratory arrest, apnea, Acute lung injury, tachypnea,minute ventilation exceeds 10 L/mt, Tachypnea, neuromuscular disorders, Hypotension,PCO2 greater than 50 mm Hg (Hypercapnia).

Left ventricular assistive devices:

It is indicated to individual with end stage heart failure. LVAD used in weakened left ventricle. Indications for LVAD are: heart failure, ehection fraction less than 25%,candidates waiting for heart transplantation.

Parenteral nutrition:

Total parenteral nutrition is a therapy used to meet nutritional needs of the patient when an individual cannot get the nutrition through eating. TPN is connected to a central vein by inserting a catheter and chest x ray is used to confirm the presence of the catheter. The TPN contents are calculated on the basis of patient age,weight,medical condition. The solutions present inside the TPN solution are dextrose,aminoacids,lipids,electrolytes (potassium,sodium,magnesium,calcium,chloride and phopshate).

Indications: Intestinal obstruction, Gastrointestinal fistula, crohns disease,ulcerative colitis,facial fractures,severe degree of burns, sepsis,gastroparesis.

Life saving treatment are stopped when there is a marked recovery in the patient condition, or when there is no marked improvement in the individual medical condition.

Ethical and legal considerations is to be met when the decision is taken to withheld or to stop life saving treatments.

Situation where life saving treatments stopped are : when the treatment is considered no longer benefit, terminally ill patient refusing to continue life saving treatments, Decision taken by advocate directives/surrogate decision makers to stop treatment.