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Analgesics or sedatives during ventilator withdrawal are intended to reduce dyspnea, anxiety, fear, or pain; the drugs of choice have been opioids and benzodiazepines. Morphine is the preferred opioid because it reduces pain, dyspnea, and anxiety and contributes to reducing excess lung water (Brody et al., 1997). Some patients - those who have severe neurological injuries or damage and who are incapable of experiencing distress, including those who have been pronounced dead by neurologic criteria - will require no analgesia.
In a prospective study of patient responses during rapid terminal weaning in an unconscious patient sample (Campbell et al., 1999), the investigators reported that many patients (35 percent) required no analgesia/sedation at any time during this procedure. There were no significant correlations between the amount of morphine used and the duration of survival afterwards. Additionally, when comparing those who received morphine and those who did not, there were no differences in length of survival. The average dose of morphine in those who required analgesia was 5.5 mg/hr.
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This online version of the book Improving Care for the End of Life: A Sourcebook for Health Care Managers and Clinicians is provided with permission of Americans for Better Care of the Dying [ www.abcd-caring.org ] and Oxford University Press. All rights reserved. For further information on quality improvement in end-of-life care visit The Palliative Care Policy Center [ www.medicaring.org ]. |
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