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A few clinicians favor the use of paralytics during ventilator withdrawal, although this practice is difficult to justify. Those who prefer it argue that continuing the paralytic drug gives the patient a comfortable appearance and precludes any sign of respiratory struggle, which could upset the family. However, the potential negative effects for the patient outweigh this positive effect for the family.
Paralytics are used to minimize oxygen consumption and regulate ventilation, but they have lost their therapeutic rationale in the situation of ventilator withdrawal. Furthermore, patients are unable to show discomfort, making it impossible for clinicians to determine whether adequate analgesia/sedation is being provided before, during, or after the ventilator withdrawal process. Paralytics do not confer any sedation or analgesic effects. Finally, if the patient is conscious, paralysis prevents physical interaction with loved ones.
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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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