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CPAP/PS without apnea alarm or backup rate kicking in
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Picture of JeffWhitnack
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See the description of a case posted below. It is Open Access at www.springerlink.com Go to Journals and find Intensive Care. (BTW in Sept. 2008, most recent one I was last there, is a GREAT one on so-called "Terminal Weaning").

Anyway,

My question. If this was to be done in your ICU: with the ventilators you use could you put a patient in CPAP/PS (whatever it's called---i.e. Spontaneous on 840) and then not have the apnea alarms/backup rate occur when "death by apnea" occurred.

I have heard it is possible with the Hamilton. ?

I am almost 100% certain not with 840 (I'm coming off vacation tonight so can't test and try).

Servo---doubt can with 300, Servo i?

Drager---I seem to recall if one goes back to original setup there are all sorts of options. If so you'd have to be sure to remember to reset it before putting on another patient.
??

Please everyone chime in and tell me if this is possible with the vent(s) you work with.

thanks,

Jeff

End-of-life decision in a paediatric intensive care unit:
>> decision making in light of the parents' religious beliefs
>> Frans B. Plötz1 , Marc van Heerde1, Martin C. J. Kneyber1 and Dick G.
>> Markhorst1
>>
>> (1) Department of Pediatric Intensive Care, VU Medical Center, P.O.
>> Box 7057, 1007 Amsterdam, The Netherlands
>>
>>
>> Frans B. Plötz
>> Email: fb.plotz@vumc.nl
>>
>> Accepted: 15 March 2008 Published online: 22 April 2008
>>
>>
>> ----------------------------------------------------------------------
>> ----------
>>
>> Without Abstract
>>
>> ----------------------------------------------------------------------
>> ----------
>>
>> Sir: Nowadays, the practice of withholding and withdrawal of
>> life- sustaining treatments in children is medically and
>> ethically acceptable when these measures can no longer yield
>> a good outcome. In North America and Europe, 28-65% of all
>> paediatric intensive care unit (PICU) deaths follow a
>> restriction in care [1]. However, clinicians' attitudes and
>> actions regarding end-of-life decisions may be altered by
>> exposure to a different culture or religion [2]. When
>> clinicians believe that life-sustaining treatment is
>> medically inappropriate or inhumane, they are not necessarily
>> obliged to provide it simply because it is demanded on
>> religious grounds by the parents. Instead, alternative
>> religious interpretations and attempts to reach a consensus
>> on the appropriate limits to life-sustaining treatment should
>> be discussed [3].
>>
>> A 7-year-old boy was diagnosed with a cerebellar medulloblastoma.
>> Complete remission was initially achieved but 6 months before
>> admission he had a relapse of the tumour without therapeutic options.
>> He developed clinical signs of an upper airway obstruction.
>> It was thought that a viral infection superimposed on his
>> vocal cords paralysis was the main cause. Life-sustaining
>> treatment was started because the viral infection was
>> considered to be an intercurrent, curable event. He was
>> intubated and assisted mechanical ventilation
>> (MV) was initiated, after which he was transferred to our PICU.
>> During the following days, his neurological condition rapidly
>> deteriorated. No signs of pain or discomfort were observed.
>>
>> The attending physician informed the parents about these
>> developments. It became apparent that the prolongation of
>> life- sustaining treatment would not contribute to a good
>> outcome. Since death was imminent, the attending physician
>> discussed the possibilities of withdrawing or withholding
>> treatment with the parents. Withdrawing treatment, i.e.
>> stopping MV, was not an option because of the parents'
>> religious beliefs. For them, such action seemed to be
>> intended to hasten death and was therefore prohibited.
>> The attending physician was concerned that the parents would
>> also object to withdrawal of MV after diagnosis of brain
>> death. After careful consideration, the attending physician
>> proposed to switch to PS/CPAP ventilation, thereby respecting
>> the wishes of the parents to continue MV. In addition, the
>> parents accepted the explanation that cessation of the
>> central respiratory drive meant a fatal progression of the
>> underlying disease, so that no change to controlled MV should
>> be made. Shortly thereafter, the boy died in the presence of
>> his parents and sister. He had experienced a fatal apnoea
>> while still intubated and on PS/CPAP. Despite their tragic
>> loss, the parents were pleased at their involvement in the
>> discussion on the end-of-life decision and satisfied that
>> their religious convictions had been respected.
>>
>> There are no paediatric guidelines for withdrawal of a life-
>> sustaining treatment like MV. The two approaches used are
>> termed "terminal extubation", i.e. removing the endotracheal
>> tube without weaning ventilatory support, and "terminal
>> weaning", decreasing ventilator support before extubation
>> [4]. This case report demonstrates that religious beliefs may
>> prohibit both approaches and provides an elegant alternative
>> in a patient with respiratory insufficiency of central origin.
>>
>> Open Access This article is distributed under the terms of the
>> Creative Commons Attribution Noncommercial License which
>> permits any noncommercial use, distribution, and reproduction
>> in any medium, provided the original author(s) and source are
>> credited.
>>
>>
>> ----------------------------------------------------------------------
>> ----------
>>
>> References
>> 1. Ten Berge J, de Gast-Bakker DAH, Plötz FB (2006)
>> Circumstances surrounding dying in the paediatric intensive
>> care unit. BMC Pediatrics 6:22
>>
>>
>> 2. Sprung CL, Maia P, Bulow HH, Ricou B, Armaganidis A, Baras M,
>> Wennberg E, Reinhart K, Cohen SL, Fries DR, Nakos G, Thijs LG, The
>> Ethicus Study Group (2007) The importance of religious affiliation
>> and culture on end-of-life decisions in European intensive care
>> units. Intensive Care Med 33:1732-1739
>>
>>
>> 3. Brett AS, Jersild P (2003) "Inappropriate" treatment near the end
>> of life: conflict between religious convictions and clinical
>> judgement. Arch Intern Med 163:1645-1649
>>
>>
>> 4. Munson D (2007) Withdrawal of mechanical ventilation in pediatric
>> and neonatal intensive care units. Pediatr Clin N Am 54:773-785
 
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